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COMMERCIAL TRANSPORTATION OPERATOR

FATIGUE MANAGEMENT REFERENCE

July 2003

U.S. Department of Transportation


Human Factors Coordinating Committee
Mr. Supple,

Please see attached, as requested. Please let me know if you have any further
questions. For further reference, this document is also posted on the HFCC website
on the OFM Program page.

Regards,

Michael Coplen
HFCC Chair

Michael Coplen, M.A.


Senior Evaluator
Manager Culture and Safety Performance Program
Human Factors R&D Program
Railroad Policy and Development, RPD-32
Federal Railroad Administration
1200 New Jersey Ave., SE, MS-20
Washington, D.C. 20590
PHONE: 202-493-6346
FAX: 202-493-6333
COMMERCIAL TRANSPORTATION OPERATOR
FATIGUE MANAGEMENT REFERENCE

July 2003

Prepared for:

U.S. Department of Transportation


Research and Special Programs Administration

K. Thirumalai, Program Manager, U.S. DOT,


Research and Special Programs Administration

Carlos Comperatore, Project Manager,


U.S. Coast Guard Research and Development Center

Prepared by:

Marvin McCallum and Thomas Sanquist, Battelle Memorial Institute


Merrill Mitler, The Scripps Research Institute
Gerald Krueger, The Wexford Group International

Work Performed Under Other Transaction Agreement No. DTRS56-01-T-003


Acknowledgements Page iii

Acknowledgments
The U.S. Department of Transportation’s Human Factors Coordinating Committee
was responsible for defining the initial objectives for the Fatigue Management
Reference and providing ongoing technical support during the conduct of this effort.
K. Thirumalai of Research and Special Programs Administration was the overall
program manager for the Fatigue Management Program. Carlos Comperatore of the
U.S. Coast Guard Research and Development Center served as the project manager
for the Fatigue Management Reference project. Antonio Carvalhais of U.S. Coast
Guard Headquarters supported management of this project and provided key
technical direction. Additional technical support was provided by Tom Nesthus of the
Federal Aviation Administration Civil Aerospace Medical Institute, Alex Landsburg of
the U.S. Maritime Administration, Stephen Popkin of the Volpe National
Transportation Systems Center, and Mike Coplen of the Federal Railroad
Administration.

Industry support and input was a critical component of this effort. Industry
participants provided their knowledge of operational challenges and successes in
managing fatigue; provided critical reviews of draft materials, and attended working
meetings to discuss how this document would be used and what it should contain.
The following members of industry directly supported this effort:
• Bill Barringer and Don Browning, Norfolk Southern
• Jennifer Carpenter, American Waterways Operators
• Cpts. Edward Davidson and Scott Hammond, Northwest Airlines, Inc.
• Cathy Deutsch, Wiseway Motor Freight
• Gabe Farra, CSX Transportation
• Dr. David Flower, British Airways
• Robert Gray, Airborne Express (ABX Air, Inc.)
• Dennis Holland, Union Pacific Railroad
• William Keppen, Consultant to The Brotherhood of Locomotive Engineers
• Mike Koppenhofer, Watkins Motor Lines
• Stacy Leathers, R.M.D.S.
• Al Lindsey, Burlington Northern & Santa Fe Railway
• John McFann, North American Van Lines, Inc.
• James Mangie, Jr., Delta Air Lines
• Jay Martin, Tidewater Marine
• Kathy Metcalf, Chamber of Shipping of America
• William D. Mitchell, CVS Transportation, Inc.
• Jeff Moller, Association of American Railroads
• Ken B. Parris, Offshore Marine Service Association
• Bob Petrancosta, Con-Way Transportation Services
• Cpt. Gene Richardson, American Airlines
• Jim Seeberger, Alaska Railroad Corporation
• Cpt. Greg Sugden, Masters, Mates & Pilots, Washington State Ferries
• Don Tullos, FedEx
Acknowledgements Page iv

• Frank Williamson, Air Line Pilots Association International

Ms. Rebecca Brewster and Mr. Dan Murray of American Transportation Research
Institute supported our liaison with the trucking industry, provided technical input, and
provided critical reviews of draft materials.

This project received a substantial level of support from several people within Battelle.
Mr. Jerry Pittenger provided ongoing management and quality guidance. Ms. Gloria
Miller and Mr. Charlie Nunn helped us forge into new territory with respect to our
working agreements between the government and our industry participants. Ms.
Barbara Steiner tracked our finite resources to ensure that we would be able to
complete our effort within our allotted budget. Ms. Mary Winter provided support in
editing and compiling this document. Finally, Ms. Judy Panjeti provided ongoing
support in communicating with our industry partners, preparing workshop and review
materials, and taking the lead in compiling, formatting, and producing the many
versions of this Fatigue Management Reference.

It was truly an honor to work with such a large group of individuals who provided their
insights and committed their efforts in support of this project.
Acronyms Page v

Acronyms
AAR Association of American Railroads
AMS Acute Mountain Sickness
ASRS Aviation Safety Reporting System
ATA American Trucking Associations
CEM Crew Endurance Management
CEWG Crew Endurance Working Group
EST Eastern Standard Time
FAA Federal Aviation Administration
FMCSA Federal Motor Carrier Safety Administration
FRA Federal Railroad Administration
NASA National Aeronautics and Space Administration
NTSB National Transportation Safety Board
OTC Over-The-Counter products
REM Rapid Eye Movement
TV Television
USCG R&D United States Coast Guard Research and Development Center
USCG United States Coast Guard
VHS Video Home System
WSF Washington State Ferries
Acronyms Page vi

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Table of Contents Page vii

Table of Contents
1. Introduction..........................................................................................................1
2. Operational Fatigue Risk Factors.......................................................................1
Introduction....................................................................................................1
Extended Work and Commuting Periods......................................................2
Split-Shift Work Schedules............................................................................4
Sleep/Work Periods Conflicting with Circadian Rhythms.............................6
Changing or Rotating Work Schedules.........................................................8
Unpredictable Work Schedules.....................................................................9
Lack of Rest or Nap Periods During Work..................................................10
Sleep Disruption..........................................................................................11
Inadequate Exercise Opportunities.............................................................12
Poor Diet......................................................................................................13
Environmental Stressors.............................................................................14
3. Fatigue Management Program Components......................................................1
Introduction....................................................................................................1
Organizational Commitment..........................................................................2
Employee – Employer Partnership................................................................4
Education and Training.................................................................................5
Employee Health Screening..........................................................................7
Program Evaluation & Refinement................................................................8
4. Fatigue Countermeasure Review.......................................................................1
Fatigue Countermeasure Review Page 4-2..................................................1
Introduction....................................................................................................1
Fatigue Countermeasure Review Page 4-2..................................................3
Countermeasures That Work........................................................................4
Adequate Sleep..............................................................................................................4
Caffeine.........................................................................................................................6
Napping.........................................................................................................................8
Fatigue Countermeasure Review Page 4-2..................................................5
Anchor Sleep...............................................................................................................10
Trip Planning...............................................................................................................12
Good Sleeping Environment.......................................................................................14
Countermeasures That Are in the Research Phase...................................16
Models of Alertness.....................................................................................................16
Fatigue Countermeasure Review Page 4-2................................................17
Fitness for Duty Testing..............................................................................................18
Alertness Monitoring...................................................................................................20
Countermeasures That Require
Supervision by a Physician.........................................................................22
Fatigue Countermeasure Review Page 4-2................................................22
Bright Light.................................................................................................................22
Stimulants....................................................................................................................24
Sedatives/Hypnotics....................................................................................................26
Melatonin.....................................................................................................................28
Table of Contents Page viii

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems...............................................30
Nicotine.......................................................................................................................30
Ventilation and Temperature.......................................................................................31
Exercise.......................................................................................................................33
Foods...........................................................................................................................35
Sound...........................................................................................................................37
Fatigue Countermeasure Review Page 4-2................................................30
Odor/Fragrance............................................................................................................38
Over-the-Counter Sleep Aids......................................................................................39
5. Sleep Basics........................................................................................................1
How to Use This Section...............................................................................1
Introduction....................................................................................................1
Overview of Sleep Basics Topics..................................................................1
Circadian Rhythms........................................................................................2
Sleep Cycles.................................................................................................4
Fatigue, Alertness, and Sleep Loss..............................................................6
Causes of Sleep Loss...................................................................................7
Getting Adequate Sleep – How to Do It........................................................9
References...............................................................................................................1
Additional Information Sources................................................................................1
Subject Index............................................................................................................1
Glossary...................................................................................................................1
1
Introduction Page 1-1

1. Introduction
Operator fatigue is a critical safety issue that affects all modes of commercial
transportation. Fatigue can induce sleepiness and drowsiness, decrease the ability of
workers to operate safely, and thereby increase the risk of fatalities and injuries.

The National Transportation Safety Board (NTSB) has found that the incidence of
fatigue is underestimated in virtually every transportation mode, because it is so hard
to quantify and measure. Many accident investigations do not obtain the information
necessary to determine the contribution of fatigue; namely, the condition of the
operators, the extent to which they have been deprived of sleep, and their state of
alertness.

Analysis of accident and incident data suggest that fatigue may contribute to between
20 and 40 percent of commercial transportation accidents. Analysis of 182 heavy
truck accidents that were fatal to the truck driver indicated that fatigue was a causal
factor in 31 percent of these crashes.1 The NASA Aviation Safety Reporting System
(ASRS) is a confidential self-reporting system for flight crews and others to report
difficulties and incidents. A study of ASRS incident reports suggests that 21% of
incidents reported since its inception were fatigue-related.2 A 1996 U.S. Coast Guard
study reports the results of analyzing 297 commercial marine casualty investigations,
using procedures specially developed to identify the contribution of fatigue to the
accidents. Analysis of these reports indicated that fatigue was a contributing factor in
16% of vessel casualties and in 33% of the personnel injuries investigated.3 Data
providing a consistent and reliable indication of the role of operator fatigue in rail
accidents are not readily available. However, researchers in this area generally agree
that fatigue is a major contributor to rail accidents.4

Managing the fatigue of commercial transportation operators requires an


understanding of the practical implications of fatigue research, as well as, the
application of appropriate fatigue management practices. Fatigue research has been
conducted to address a wide range of issues and operational settings. A number of
operator fatigue management training workshops, guidelines, and handbooks have
been developed to aid in the development of individual fatigue management
programs. Fatigue management program elements and fatigue research findings can
be extracted from earlier efforts that have general applicability across a range of
commercial transportation modes.
1
National Transportation and Safety Board. (1990). Fatigue, alcohol, other drugs, and medical
factors in fatal-to-the driver heavy truck crashes (Safety Study 1990, NTST/SS-90/01),
Washington, DC.
2
Graeber, R. C. (1985). Proceedings of the Flight Safety Foundation 38th International Air Safety
Seminar.
3
McCallum, M. C., Raby, M., & Rothblum, A. M. (1996). Procedures for investigating and
reporting human factors and fatigue contributions to marine casualties (Final Report No. CG-D-
97). Washington, DC: United States Coast Guard.
4
Sussman, D., & Coplen, M. (March 2000). Fatigue and alertness in the United States railroad
industry. Part I: The nature of the problem. Fourth International Conference on Managing
Fatigue in Transportation. Freemantle, Australia.
Introduction Page 1-2

In recognition of the opportunity to provide a general fatigue management resource


with broad applicability, the U.S. Department of Transportation’s modal agencies are
currently addressing fatigue management through a multi-modal, coordinated Fatigue
Management Program. The development of this Fatigue Management Reference
represents a portion of that programmatic effort. The purpose of this reference is to
provide basic information to the transportation industry that can be used to enhance
the content of fatigue management guidelines, handbooks, and educational materials.
Objectives defined in support of this effort are:
• Compile information regarding those factors that can serve as indicators of
potential fatigue problems within the commercial transportation industry,
• Describe the basic components shared by fatigue management programs
within the commercial transportation industry, and
• Provide a series of summaries that address what is and what is not known
regarding the efficacy, implementation, and limitations associated with
fatigue countermeasures commonly employed in commercial
transportation operations.

This Fatigue Management Reference has been developed with support from a group
of 25 individuals who are central to operator fatigue management efforts for their
organizations. Members of this group represent the airline, railroad, maritime, and
trucking industries. The industry contributors shared the challenges they have faced
and the lessons they have learned in managing operator fatigue within their
organizations, shared the information resources they have used in managing fatigue,
and served as critical reviewers of draft versions of this Fatigue Management
Reference. A group of industry and government researchers also contributed to this
reference by reviewing fatigue management research to date and compiling two
sections that provide information on fatigue countermeasures and sleep basics.

This document contains nine sections,


Acronyms – provides a listing of all acronyms used in this reference.
Operational Fatigue Risk Factors – identifies those aspects of commercial
transportation operations that may be associated with higher risk of operator
fatigue.
Fatigue Management Program Components – outlines the basic
components of ongoing, evolving, and successful alertness management
programs in the commercial transportation industry.
Fatigue Countermeasures Review – summarizes what can be concluded
from research regarding the use of those fatigue countermeasures that are
most commonly considered for application in the commercial transportation
industry.
Sleep Basics – provides information to support a basic understanding of the
physiological and behavioral mechanisms that govern fatigue.
References – includes citations of all published research reports cited in the
body of this document.
Additional Information Sources – lists reports and other documents that
provide additional information on this topic.
Introduction Page 1-3

Subject Index – provides a listing and page index to selected topics


addressed in this document.
Glossary – provides definitions for various terms and concepts presented in
this document
Introduction Page 1-4

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Operational Fatigue Risk Factors Page 2-1

2. Operational Fatigue Risk Factors


Introduction
Many factors associated with operator fatigue are common across transportation
modes. This section discusses several general operational fatigue risk factors that
were identified during structured interviews with representatives from the airline,
railroad, maritime, and trucking industries.

When these factors are present, there is an increased likelihood that operators are
working in a state of fatigue. Operational issues associated with these factors are
discussed, and specific examples are identified within the airline, railroad, maritime,
and trucking industries. By reviewing this section, commercial transportation
operators can begin to identify the factors that may be of concern in their particular
operations.

The operational fatigue risk factors discussed in this section are:


• Extended Work and/or Commuting Periods
• Split-Shift Work Schedules
• Sleep/Work Periods Conflicting with Circadian Rhythms
• Changing or Rotating Work Schedules
• Unpredictable Work Schedules
• Lack of Rest or Nap Periods During Work
• Sleep Disruption
• Inadequate Exercise Opportunities
• Poor Diet
• Environmental Stressors
Operational Fatigue Risk Factors Page 2-2

Extended Work and Commuting Periods


Most commercial transportation operator work-hours are
regulated by Federal hours-of-service rules. Therefore,
long work hours seldom independently result in operator
fatigue. Rather, it is the combination of long work periods
and other non-duty factors that contribute to on-the-job
fatigue, by limiting the available time for recreation, rest,
and sleep. Over extended working periods, repeated inadequate sleep periods can
result in accumulated sleep debt and associated operator fatigue. Among the primary
aspects of extended work and/or commuting periods that have been cited as
contributing to operator fatigue are:
 Long commutes to or from work on a daily basis
 Long waits after reporting for work before duty begins
 Forced interruptions in work that extend the duty day
 Long commutes from home to report for work prior to beginning a multi-day
work period

Examples in Commercial Transportation

Airlines
• Crewmembers who have a minimum 8- or 9-hour rest period might not have
schedule allowances for local commutes, meals, and personal care that can
result in a sleep opportunity of less than 5 hours.
• Many airline crewmembers have long commutes to and from their home base.
These commutes might not be taken into account by the individuals involved
to ensure adequate rest prior to the upcoming work period.

Railroads
• Inadequate time for sleep can result from 12 hours on the job, coupled with
the time required for local commutes, meals, personal care, and calls to or
from the job dispatcher.
• Railroad employees can be on duty 18-20 hours or more, if stranded or in
combination with deadhead moves.

Maritime
• Officers on deep draft vessels with collateral administrative or cargo duty
might have limited time for sleep.
• Offshore supply vessel crews might report at company headquarters for the
beginning of a work cycle, which is immediately followed by an extended
commute to the vessel and reporting for work.

Trucking
• Drivers working regional or local routes sometimes perform dock work that
breaks up their driving period, but adds to the duty period.
Operational Fatigue Risk Factors Page 2-3

• Drivers often must wait for their truck to be loaded or unloaded before
resuming driving, adding to the length of their duty day and reducing
opportunities to obtain satisfactory sleep. Often during these periods, drivers
do not have the opportunity to nap.
Operational Fatigue Risk Factors Page 2-4

Split-Shift Work Schedules


Split-shift work can increase the likelihood of operator fatigue, by
resulting in schedules that are not conducive to obtaining
adequate sleep during the normal sleep period. Among the
primary factors that commonly occur in conjunction with split-shift
schedules contributing to operator fatigue are:
 Early morning start of shift
 Late evening end of shift
 High-paced operations during the work period
 Limited time at home during the awake period
 Difficulty in taking advantage of mid-day sleep opportunities

Examples in Commercial Transportation

Airlines
• Cargo, commuter, and other operations result in split shifts, with off-duty rest
available for the crew either at an airport rest area or at off-site
accommodations. Factors that can compromise obtaining rest, and thereby
contribute to fatigue include: non-use of the rest facilities by crewmembers,
facility conditions not conducive to rest, and the time of day.

Railroads
• Commuter operations can result in AM/PM split-shift operations with long
periods away from home and insufficient time available for sleep.

Maritime
• Towing and offshore supply vessel crewmembers typically work a “square
watch” of 6-hours-on/6-hours-off. There are pros and cons to these shifts
versus 12-hours-on/12-hours-off schedules on offshore supply vessels and
tugs working relatively high tempo operations: 6-hours-on/6-hours-off have
shorter continuous work periods but result in multiple sleep periods, some with
poor times; but 12-hours-on/12-hours-off have long work periods that may be
too long if the physical or mental demands of the job are high, but provide for
one continuous sleep period.
• Offshore supply vessel engineers will often have highly fragmented schedules,
as they must be on duty when pumping product.
• The traditional deep-water watch schedule is 4-hours-on/8-hours-off with
additional duties during daylight hours. The most challenging schedules are
those that involve watches during normal sleep periods, and sleep during
normal awake periods; that is, those that include the 0000-0400 hours and
0400-0800 hours watch periods.
Operational Fatigue Risk Factors Page 2-5

Trucking
• The 24/7 nature of over-the-road (long-haul) driving often requires work during
both the daytime and the nighttime, resulting in fragmented sleep and sleep
opportunities at times not conducive to sound sleep.
• Team drivers may alternate driving and sleeping in the berth during travel,
resulting in a split-shift work schedule.
Operational Fatigue Risk Factors Page 2-6

Sleep/Work Periods Conflicting with Circadian Rhythms


When work schedules require people to obtain their sleep
during times that are normally awake periods, the quality
and quantity of sleep suffers. Work during “low” periods of
the circadian rhythm (approximately 0100-0400 hours and
1300-1600 hours) can be associated with drowsiness and a
low level of alertness.

Inappropriate times to obtain sleep include:


 Late morning (for those adjusted to a nighttime
sleep schedule)
 Afternoon (for those adjusted to a nighttime sleep schedule)
 Early evening (for those adjusted to a nighttime sleep schedule)
 Any shift in sleep time due to travel across time zones that requires sleep
during the day at the origin of travel (i.e., the jet lag phenomenon)

Examples in Commercial Transportation

Airlines
• International and transoceanic flights commonly have a domestic departure in
the evening, resulting in all-night flights, followed by early morning return
flights after a disrupted sleep period.
• Early wake-up times for early morning departures (e.g., 0300 hours wake-up
for a 0600 hours departure) lead to fatigue problems that are difficult to
compensate for by an earlier bedtime because the bedtime will be prior to a
normal sleep period.
• Senior pilots will often select long-haul schedules that result in the most
demanding work schedules because these typically result in the highest
compensation and/or extended time at home.

Railroads
• Crewmembers frequently work various schedules over a period of days or
weeks resulting in available sleep times that are at the wrong physiological
time.
• The off-duty time of railroad crewmembers is frequently seen as the
responsibility of the individual worker, even though work schedules might
result in physiologically challenging sleep schedules.

Maritime
• A 6-on/6-off “square watch” starts at either 0000 or 0600 hours, with morning/
evening sleep periods of 0000-0600 hours and 1200-1800 hours, which
coincide reasonably well with normal circadian rhythms. However, the
midnight/afternoon watch has sleep periods from 0600-1200 hours and 1800-
0000 hours, which are at the wrong physiological times.
Operational Fatigue Risk Factors Page 2-7

• Offshore supply vessel crew schedules are typically 12-on/12-off, beginning at


0600 and 1800 hours. This regimen results in a challenge for crewmembers
scheduled to sleep between 0600-1800 hours because this sleep period is
inconsistent with a normal nighttime sleep schedule. In addition, rest during
this period can be further compromised by interruptions for docking and
transfers.
• Deep draft vessel watch schedules are typically 4-hours-on/8-hours-off, with
the most challenging schedules being those that involve watch schedules
during normal sleep periods, and sleep during normal awake periods – those
that include the 0000-0400 hours and 0400-0800 hours watch periods.

Trucking
• Long-haul driving often requires work during both the daytime and the
nighttime, resulting in fragmented sleep and sleep opportunities at times not
conducive to sound sleep.
• Local night routes and cross-country routes often involve nighttime driving and
daytime sleeping.
• Team drivers might alternate driving and sleeping in the berth during travel,
resulting in split-shift work schedules and scheduled sleep periods not
conducive to sound sleep.
• Night drivers commonly shift to daytime schedules on weekends or days off,
resulting in weekly disruption of their usual sleeping period.
• Depending on a drivers work schedule, Hours-of-Service rules can require the
employer to schedule employees for off-duty periods that are not conducive to
sleep (e.g., 1600-0200 hours), resulting in low-quality sleep immediately
followed by a driving period beginning during a “low” circadian period (i.e.,
0200 hours).
Operational Fatigue Risk Factors Page 2-8

Changing or Rotating Work Schedules


Many commercial transportation operations require
frequent changes or rotations in schedule. These schedule
shifts lead to relatively quick changes in the time of day at
which operators can obtain sleep, generally resulting in
inadequate levels of rest. Changing or rotating work
schedules can be characterized as follows:
 Changes in work and rest schedules that do not
have a fixed pattern and thereby result in fatigue
management challenges that are extremely difficult
to address
 Rotating schedules that have fairly systematic shifts in the work start and stop
times

Examples in Commercial Transportation

Airlines
• Crewmembers who work for supplemental operators (i.e., cargo carriers) often
work at night; then, when off-duty, they might revert to a nighttime sleep
schedule.

Railroads
• The generally unscheduled nature of freight operations in North America
contributes to erratic duty start times.
• Many crews are rotated in “pools” on a first-in, first-out basis, often with no
regularity in duty period. All possibilities of changing schedules (backward,
forward, swing) are seen.

Maritime
• Crewmembers are required to be available on an as-needed basis to assist in
mooring and transfer operations that are subject to changing schedules.
• Vessel captains are typically required on the bridge entering and leaving port,
resulting in erratic work hours, especially on shorter routes.

Trucking
• Drivers who are “on call” for available work frequently do not have a fixed
schedule.
• Drivers who must rely on a dispatcher to schedule pick-ups and deliveries are
subject to changing schedules.
• Drivers who normally work at night may revert to a nighttime sleeping
schedule when they return home.
Operational Fatigue Risk Factors Page 2-9

Unpredictable Work Schedules


The amount of advance notice that commercial transportation
operators have regarding their work schedule varies substantially.
An unpredictable schedule can lead to forced changes in sleep
times and therefore in low-quality sleep. Unpredictable schedules
can also cause workers to wake sooner than necessary in order to
check in with dispatchers. Conditions commonly associated with
unpredictable work schedules include:
 Being “on-call” for work without a fixed schedule
 First-in, first-out work pool scheduling
 Schedule delays resulting from equipment, weather, or traffic problems

Examples in Commercial Transportation

Airlines
• Weather, traffic, and mechanical problems can result in unexpected delays.
• On-call crewmembers have limited advance notice regarding their schedules.

Railroads
• Employees who work “on call” (rotating frequently between day and night work
schedules) account for between 40 and 60 percent of all crews.

Maritime
• Crewmembers typically have well-defined work periods. However, operational
demands (docking, cargo transfer, or weather) can result in interruptions.

Trucking
• Driver work schedules at some trucking companies change on a weekly basis.
• Drivers who are “on call” for work have limited advance knowledge of their
schedules.
• Drivers frequently experience delays in cargo delivery, loading, or unloading
that force them to change their work schedule, varying on-duty versus driving
time.
Operational Fatigue Risk Factors Page 2-10

Lack of Rest or Nap Periods During Work


Taking a brief rest or nap during a work period is a
controversial topic in some transportation settings while
it is considered the norm in others. Research has
demonstrated the value of planned napping to
supplement sleep and to temporarily restore alertness
on the job. Lack of rest or nap periods can result from:
 Company policies that restrict or prohibit
napping
 Federal regulations that restrict or prohibit napping
 Unwillingness of operators to take naps

Examples in Commercial Transportation

Airlines
• FAA regulations forbid on-duty crewmembers from taking naps on domestic
flights.
• Rest breaks of 2 to 3 hours are scheduled on long-haul international flights
having 3 or 4 crewmembers – the first rest period is least desirable, middle
most, last period next best.

Railroads
• Most railroads in North America now have policies that allow operating crews
to nap under controlled conditions.

Maritime
• Crewmembers typically can only take advantage of napping opportunities
during off-watch periods at port or during limited transit periods.

Trucking
• Companies vary in their napping policies for “long-haul” operations.
• Long-haul drivers typically nap on an as-needed basis. The naps taken are
often extended and more accurately reflect split-shift schedules.
• Long-haul drivers typically know their routes and the locations of good rest
stops and therefore can plan when and where to take naps, however,
• The lack of adequate rest stops limits the opportunity for resting or napping on
many routes.
Operational Fatigue Risk Factors Page 2-11

Sleep Disruption
Interrupting or disturbing sleep can make returning to sleep
more difficult. It has been shown that both the number and
timing of disruptions can affect daytime sleepiness and
fatigue. Some general factors that disrupt sleep in
commercial transportation operations include:
 Noise, vibration, movement, uncomfortable
temperature, and poor air quality in sleeping quarters
 Unfamiliar environments away from home with less than optimal conditions
 Attempting to sleep at an inappropriate time for one’s circadian rhythm
 Sleep at home or at hotels during normal awake periods can be disturbed by
poor light shading, normal daytime noises, and sub-optimal heating and air
conditioning

Examples in Commercial Transportation

Airlines
• Crewmember rest can be disrupted by unpredictable aircraft movement,
turbulence, vibration, and/or noise.

Railroads
• Crewmember rest can be disrupted by dispatchers, who are allowed to call
crewmembers regarding upcoming work up to 90 minutes before report time.

Maritime
• Live-aboard crewmembers must often deal with sleep disruption due to
vibration, noise, and motion.
• Work-related interruptions during scheduled sleep periods are a common
problem on many vessels.
• Sleep disruption tends to be common aboard at-port vessels because docks
are busy and vessels must move frequently.
• Senior deck officers must balance bridge availability during operations with
significant risk (docking, etc.) and the cost in disrupted sleep and cumulative
fatigue.

Trucking
• Drivers with sleeper berth cabs face the challenges of either noisy rest stops
or trying to sleep in the vehicle while traveling.
Operational Fatigue Risk Factors Page 2-12

Inadequate Exercise Opportunities


People who exercise regularly have fewer episodes of
sleeplessness. Isolated exercise, while not an effective
countermeasure for immediate fatigue, can improve sleep
quality by promoting smoother, more-regular transitions
between the cycles and phases of sleep. Moderate
exercise lasting 20 to 30 minutes, three or four times a
week, promotes sleep. Exercise in the morning or
afternoon is preferred, because exercise close to bedtime can disrupt the onset of
sleep. A brisk walk can be very beneficial, although more vigorous exercise has been
shown to provide increased health benefits. Exercises designed for environments
with restricted space have also been shown to be beneficial. Factors that may limit
exercise opportunities include:
 Personal habits might need to be overcome in initiating an exercise program
 Work schedules might need to be adjusted to include appropriate exercise
opportunities
 Travel or living conditions can limit access to exercise equipment or space

Examples in Commercial Transportation

Airlines
• Crewmembers whose workdays are extended can have difficulty obtaining
adequate exercise well in advance of their sleep period.

Railroads
• Crewmembers whose workdays are extended can have difficulty obtaining
adequate exercise well in advance of their sleep period.

Maritime
• Crewmembers who work onboard frequently have limited exercise options.
Some deep-draft vessels provide exercise equipment and/or have an
adequate area for walking.
• Some maritime companies regard exercise equipment as dangerous under
their operating conditions. In general, maritime workers must establish a
regimen of exercise in a confined space with limited equipment.

Trucking
• A number of companies have been encouraging their drivers to take a brisk
walk mid-day, prior to lunch.
• Truckers generally have difficulty making suitable time available for exercise,
locating appropriate places to exercise, and ensuring privacy and personal
security while exercising.
Operational Fatigue Risk Factors Page 2-13

Poor Diet
What we eat can be a determining factor in sleep quality
and duration. Some of the dietary behaviors that can
disrupt sleep include:
 Eating heavy or spicy foods just prior to bedtime,
which can interfere with sleep by causing heartburn
 Consuming alcohol just prior to bedtime can induce sleep initially, but tends to
lead to fragmented sleep
 Consuming caffeine within 4 to 6 hours before bedtime can delay the onset of
sleep as well as disrupt sleep

Examples in Commercial Transportation

Airlines
• Meals provided in flight might not be appropriate for a crewmember’s work
schedule.

Railroads
• Hotel menus with limited healthy entrees cannot always be avoided, because
many on-route hotels are located in sparsely populated areas with few
available alternatives.
• Meals available to crews might not be appropriate for a crewmember’s work
schedule.

Maritime
• Menus traditionally include large servings of carbohydrates and fried foods.
• On smaller vessels, prepared meals might be limited to one per day.
• On board, the availability of fresh fruits and vegetables might be limited.

Trucking
• Drivers are not traditionally the healthiest of eaters, and truck stops are not
traditionally the healthiest of purveyors.
• Although drivers can take food with them, poor dietary habits and/or a lack of
dietary education often lead them to choose foods that are less than healthy.
Operational Fatigue Risk Factors Page 2-14

Environmental Stressors
Several environmental factors can adversely affect a
commercial transportation operator’s level of alertness.
These include environmental aspects related to heat,
humidity, cold, altitude, vibration, and noise.

Heat and Humidity


Generally, one experiences high ambient temperatures
as dry heat (temperature above 85° F, humidity less than 50%), or as humid
(temperature above 85° F, humidity above 80%). All excessively hot conditions will
make an operator feel less alert and generally more fatigued. Hot and humid working
conditions can be significantly more detrimental to worker performance than can hot-
dry conditions, and will usually make one feel “fatigued” much sooner than will
temperatures less than 75° F. The increased feeling of fatigue attributable to hot-
humid conditions manifests itself in the form of excessive perspiration, dehydration, a
sense of tiredness, and a generalized feeling of physical and mental fatigue. Using
air-conditioning, taking frequent rest breaks, and drinking lots of fluids (preferably
water) can help ward off the fatiguing effects of high ambient temperatures.

Cold
Cold weather can indirectly contribute to operator fatigue. Operators often wear
several layers of clothing during cold weather, which can make using restroom
facilities more difficult, which in turn can lead operators to reduce the amount of
liquids they consume. Reduced liquid consumption can then lead to dehydration,
which can cause operators to become fatigued more quickly than usual. Following a
good regimen of fluid intake is recommended.

Aviation Altitude
At high altitudes, commercial crews often travel for extended periods in cabins
pressurized at the 6,000- to 7,000-foot level. Breathing air at this level, with its
reduced oxygen concentration, can lead to a general sense of fatigue, especially
when the body is subjected to periodic rises and falls in pressurization.

High Terrestrial Altitude


Driving at altitudes in excess of 5,000 feet can increase a driver’s respiration and
heart rate; and sleeping at high altitudes can result in blood pooling in the arms and
legs, which can cause the general malaise and discomfort that accompanies Acute
Mountain Sickness (AMS). These effects dissipate as one acclimates to a higher
altitude, usually in a matter of a few days. Drivers should be aware of the effects of
high altitude, and, if at all possible, should avoid sleeping at high altitudes.

Whole Body Vibration


Whole body vibration and acceleration accompany operation of several types of
transportation vehicles, including aircraft, helicopters, large trucks, trains, ships, and
small vessels. Operation of helicopters, automobiles, trucks, etc., exposes operators
to increasing acceleration magnitudes, with a frequency range extending up to
Operational Fatigue Risk Factors Page 2-15

100 Hz, depending on the roughness of the air/road/seas and the vehicle speed.
Ship-at-sea motions can extend from the extremely low frequencies produced by
ocean waves (below 0.1 Hz) to the high frequencies produced by high-speed surface
ships. Occasional air turbulence can superimpose vibration and buffeting on
sustained accelerations in commercial aircraft. Although most operators consider
these to be lower-level fatiguing effects, they can add to operators’ general feeling of
fatigue, thereby lowering their alertness while operating equipment, especially if they
are exposed to these effects over long duty days.

With the help of air traffic controllers, commercial pilots in “rough air” seek out less
vibratory altitudes for the comfort of their airline passengers. Truck drivers often avoid
roads known to be rough, especially if they are team-drivers with one driver
attempting to sleep in a sleeper-berth while the other drives. As potential
countermeasures, operators can install high-quality shock-absorbing systems, sit on
air-cushioned seats, or avoid vibration environments.

Acoustical Noise
Operators are exposed to engine noises in all transportation vehicles, as well as to
related noises emanating from aircraft controls, vehicle transmissions, braking
systems, and wind streams. Some people regard these noises more as a hearing-
conservation issue than as a fatigue issue. In fact, wearing ear protection in the
presence of these noises is often called for; however, these noises can also
contribute to an operator’s level of fatigue. The continuous “hum” and other
intermittent noises of most running engines, especially in hot and stuffy crew
compartments, can contribute to the hours of boredom one can experience on lengthy
trips. Being aware that noise can contribute to one’s overall feeling of operator
fatigue is an important step toward ensuring that operators take occasional rest
breaks.
Operational Fatigue Risk Factors Page 2-16

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Fatigue Management Program Components Page 3-1

3. Fatigue Management Program Components


Introduction
Commercial transportation operator fatigue is best managed by an integrated
program that addresses the requirements of all stakeholders in the operational
community. Evolving fatigue management programs often begin by attempting to
implement countermeasures in the absence of such a program. However, this
approach typically meets with limited success, because the individual
implementations are not sufficiently understood or supported by all those affected by
them. More mature and established fatigue management programs, on the other
hand, introduce fatigue countermeasures from a foundation of organizational
commitment, cooperation, knowledge, assessment, and program refinement.

A number of comprehensive program guides, developed for specific transportation


modes, provide useful models of fatigue management program practices for the
modes addressed.5 In addition, specific programs tailored to the requirements of
individual organizations have been developed by a number of commercial
transportation organizations.6 These guides share a number of themes and lessons in
common, suggesting a central core of key fatigue management program components.
Taken as a starting point, these key components can be tailored to the operational
requirements of individual transportation organizations.

This section discusses the general nature of the key components of fatigue
management programs, and provides examples that have been obtained from
industry participants on this project. The following five program components are
discussed in the remainder of this section:
• Organizational Commitment
• Employee-Employer Partnership
• Education and Training
• Employee Health Screening
• Program Evaluation and Refinement

5
Selected examples of modal guides include: The Alert Driver – A Trucker’s Guide to Sleep,
Fatigue, and Rest in our 24-Hour Society, American Trucking Associations, Inc., and the Federal
Motor Carrier Safety Administration, 1997; Crew Factors in Flight Operations X – Alertness
Management in Flight Operations, NASA Ames Research Center, 1999; Management of
Endurance Risk Factors – A Guide for Deep Draft Vessels, United States Coast Guard Research
and Development Center, 2001; Shiftwork Coping Strategies, FAA Civil Aerospace Medical
Institute, 2001; and Toolbox for Transit Operator Fatigue, Transportation Research Board, 2002.
6
Selected examples of fatigue management program guides developed by individual commercial
organizations are: The Alert Employee – A Guide to Sleep, Fatigue, and Rest in our 24-hour
Society, Federal Express, 1997; Alertness Management Guide, Delta Air Lines, 2001; and Crew
Endurance Management Practices for Washington State Ferries, 2003.
Fatigue Management Program Components Page 3-2

Organizational Commitment
In order to succeed, a fatigue management program needs
visibility and support at the highest levels in the
organization. Organizational commitment requires the
allocation of resources sufficient for establishing and
sustaining a fatigue management program. Involvement by
the upper levels of the organization in supporting,
monitoring, and refining the program is required for
continued program success.

Senior executives should be involved in the formulation and support of their


organization’s fatigue management policy. Program policies should be established
through a joint effort by all organizational stakeholders. The policy might include:
• Statement of goals and objectives
• Responsibilities and authority for managing fatigue and alertness
• Documentation of the support and expertise available to the program
• Policies regarding employee alertness and fatigue
• Objectives and methods for program evaluation and refinement

Each of the four commercial transportation modes that have actively participated in
the present project operates under hours-of-service rules. Thus, every organization
must, to some extent, address operator fatigue in their operations. However, there is
ample evidence that meeting the nominal requirements of current hours-of-service
rules is not sufficient to effectively manage operator fatigue – additional efforts are
required. There are numerous examples of organizational commitments to manage
operator fatigue beyond hours-of-service rules within commercial transportation.
However, rather than identifying any specific company’s activities in this regard, it
may be more useful to characterize the general nature of commitment within the
airline, railroad, maritime, and trucking industries.

The airline industry has long been considered a safety critical industry, with a
substantial level of effort devoted to engineering and operational safety. Following
the introduction of the NASA Ames Fatigue Management Training Module,
organizational involvement among airlines generally grew. At present, most U.S.
airline carriers have established some variant of a fatigue management program.

The railroad industry has been a leader in fatigue management, sponsoring a


substantial level of research, and committing to long-term programs, in spite of many
economic disincentives for reducing worker hours. Sherry7 describes numerous early
efforts to establish and test modified work/rest schedules in an effort to reduce on-the-
job fatigue.

The maritime industry was introduced to fatigue management somewhat later than
the airline and railroad industries. Following the release of a study documenting the
substantial role of fatigue in maritime casualties by the Coast Guard in 1996,8 there
has been a growing involvement in fatigue management within this industry. The
7
Sherry, P. (2000). Fatigue Countermeasures in the Railroad Industry: Past and Current
Developments. Washington, DC: Association of American Railroads.
Fatigue Management Program Components Page 3-3

Coast Guard leads this effort, providing assistance and guidance through its Crew
Endurance program to maritime companies willing to invest in fatigue management.

The trucking industry is extremely diverse, in both the size of organizations and the
nature of operations. Not surprisingly, this diversity has resulted in a wide range of
levels of commitment by operating companies. Some trucking carriers have well-
established, integrated programs, while others simply manage hours-of-service.
However, it is noteworthy that industry organizations (e.g., American Trucking
Associations) with the support of the federal government have developed educational
programs that are proving quite effective in introducing the issues associated with
truck driver fatigue and fatigue management.

8
McCallum, M. C., Raby, M., & Rothblum, A. M. (1996). Procedures for investigating and
reporting human factors and fatigue contributions to marine casualties (Final Report No. CG-D-
97). Washington, DC: United States Coast Guard.
Fatigue Management Program Components Page 3-4

Employee – Employer Partnership


It is a challenge for employees and employers to
address fatigue management from a common
perspective. At issue are work and rest schedules,
which directly affect both operational efficiency and
operator well being. On the other hand, because these
issues are so critical to the organization and individuals
(reducing on-the-job accidents, improving employee
health, and improving operational efficiency), they can
also serve as an important basis upon which to establish more productive
relationships. An effective alertness management program must identify a means of
involving both employees and employers in supporting these common objectives.
Employees and employers are most effective when they work together to address
employee fatigue.

The Association of American Railroads (AAR) provides a relatively early example


of employee-employer cooperation in fatigue management. In 1992, AAR began
research of the work/rest and fatigue issues through the formation of the Work Rest
Task Force with participants from a number of major railroads and unions. The
planned research had two major objectives: (1) to create a validated system for
describing and measuring factors associated with work schedules in the railroad
industry; and (2) to determine, if possible, how accidents and injuries are related to
measurable work factors. Over a period of four years, using data from five major
railroads, researchers met the first objective by developing methods for describing
and translating shift work data. The second objective has not yet been satisfactorily
achieved. The Work Rest Task Force is continuing its efforts to address the fatigue
concerns in the industry. The Task Force collaborated with the North American Rail
Alertness Partnership, consisting of members from the Federal Railroad
Administration (FRA), rail labor unions, and the carriers, to identify the key principles
of an effective fatigue countermeasures program. A committee of senior railroad
executives officially endorsed the list on February 23, 1998 and railroads are
continuing to integrate the countermeasures principles into their individual programs.

The Washington State Ferry System (WSF) provides a more recent partnership
example in the maritime industry. In 2001, at the urging of the United States Coast
Guard, the WSF formed a Crew Endurance Working Group. The group consisted of
WSF management, the U.S. Coast Guard (USCG) Research and Development
Center team, and employee representatives. The purpose of the group was to study
crew endurance and fatigue factors at WSF and to improve conditions that were
found. WSF dedicated the funds necessary for the meetings and the ongoing
education and training. The USCG R&D team acted as facilitators at the meetings
and provided research and data for the group to consider. They have studied various
crew work schedules and provided information needed for training and education for
fleet personnel. The USCG Marine Safety Office representatives were there on
behalf of the USCG which has regulatory responsibility over working conditions on
WSF vessels. Employee representatives supporting fleet personnel have become
“Crew Endurance Coaches,” and are involved in ongoing training and education. At
the time of this writing, the group still meets on a regular basis and both employers
and employees are now fully committed to the Crew Endurance Working Group and
the ongoing program.
Fatigue Management Program Components Page 3-5

Education and Training


Education and training provide the knowledge required to
support the fatigue management program at all levels.
Education should address the physiological mechanisms that
underlie fatigue, provide specific recommendations for
countermeasures, and be industry specific. Information
should be distributed industry-wide through a range of
forums and formats. Information should be provided
frequently, in order to foster behavioral change. Periodic
revision of training materials is required to incorporate new
information and techniques.

Union Pacific Railroad has a long-standing education and training program for
employees. This program, called the Alertness Management Program has been
developed and delivered at three levels:
1. A short video program is used at company meetings and in a safety blitz
format.
2. A video program is used in conjunction with a trained facilitator.
3. A live presentation is given by a trained facilitator.

Washington State Ferries, in its recent efforts to address operator fatigue, has
confronted the basic requirement of educating the workforce prior to introducing major
changes in work schedules. One of the first actions of Washington State Ferries’
Crew Endurance Working Group (CEWG) was to drastically alter some longstanding
work schedules. Although it had been shown that these work schedules had negative
health and safety implications, changing them was very unpopular with fleet
personnel who had become accustomed to them over a long period of time. The
CEWG quickly recognized the need for training and education and had CEWG
members visit every crew and provide information regarding proper diet, exercise,
and sleep. The WSF Fire and Safety Training book was updated with information
regarding Crew Endurance. All new employees and new Deck Officers were trained
in endurance and fatigue management during their orientation. Even after this
educational effort, there continues to be resistance from rank and file personnel.
Change does not come easily to people who feel that their lives have been disrupted;
so the training is being expanded and presented to all vessel crews during a one-day
seminar on various safety issues, with a segment devoted to endurance and fatigue.
The training is being conducted by employee representatives of the CEWG using
information provided by the USCG R&D Center team. There has been some very
gradual shifting of attitudes from fleet personnel regarding work scheduling and
fatigue management, and people are starting to understand the importance of proper
sleep, exercise, and diet.

Since 1996, the Federal Motor Carrier Safety Administration and the American
Trucking Associations have co-sponsored and conducted “train-the-trainer” fatigue
management courses for over 3700 safety and risk managers in the trucking industry.
The goal is to provide training material to safety officers, which they can use to foster
alertness and fatigue management programs in their own companies. The program
offers a 19-minute family-oriented VHS video on driver fatigue, accompanying helpful
booklets and pamphlets, a set of over 50 PowerPoint slides, and a comprehensive
Fatigue Management Program Components Page 3-6

lecture to accompany the course. The FMCSA-ATA course, Mastering Alertness


and Managing Commercial Driver Fatigue, covers such topics as: the importance of
obtaining adequate rest and sleep, body and sleep physiology, circadian rhythm
effects, shift-lag influences from rotating work schedules , sleep disorders, the
influences of chemical substances, a list of drowsy driver warning signals, and a set
of fatigue countermeasures.
Fatigue Management Program Components Page 3-7

Employee Health Screening


Sleep disorders (Insomnia, Sleep Apnea, Snoring,
Restless Leg Syndrome, and Narcolepsy) disrupt sleep,
and can lead directly to operator fatigue, or exacerbate
fatigue associated with a challenging work schedule. There
are a number of self-screening tools for fatigue that can be
used by operators to determine their need for further help.9

A sleep diary, compiled by you and your sleep partner, can highlight lifestyle factors
related to sleep disorders, and help your doctor or sleep specialist, if you choose to see
one. A sleep diary should record all sleep-related information, including:

• time you went to bed and woke up (total sleep hours)


• quality of your sleep - times that you were awake and activity (e.g., stayed in bed
with eyes closed, or got up, had a glass of milk, and meditated)
• types and amount of food, liquids, caffeine, or alcohol you consumed before bed,
and times of consumption
• feelings and moods before bed – happiness, sadness, stress, anxiety
• drugs or medications taken, amounts taken, and times of consumption

Several railroad carriers have confidential screening programs in place that provide
employees information about sleep disorder symptoms and information about where
to go for help. Carriers have experimented with formal medical screening but find that
employees are more comfortable with and more likely to use confidential voluntary
programs.

American Trucking Associations’ The Alert Driver guide includes a comprehensive


chapter entitled Do You Have a Sleep Disorder? The chapter includes sections
addressing sleep apnea, insomnia, leg twitches, narcolepsy, advanced and delayed
sleep phase syndrome, and advice on seeing a doctor if a serious sleep disorder is
suspected.

9
The National Sleep Foundation provides a useful Excessive Daytime Sleepiness Questionnaire
that can be accessed and scored online at the following world wide web site:
http://www.sleepfoundation.org/epworth/quiz.html. Accessed July 9, 2003.
Fatigue Management Program Components Page 3-8

Program Evaluation & Refinement


A fatigue management program requires periodic
evaluation and refinement, as with any other aspect of an
effective business operation. Program evaluation should
be linked to the established objectives. Measures that
could be collected on an ongoing or periodic basis include:
hours of charged operator overtime, average number of
operator sick days, number of accidents and incidents
found to have resulted from operator fatigue, attendance at
alertness management educational events, number of operators completing
confidential fatigue-screening, and operator responses to a periodic alertness
management survey.

Program refinements close the gap between established objectives and evaluation
findings. The process of effectively managing operator alertness inevitably involves
coordinating efforts across many members and levels of an organization. Successful
refinement requires continued oversight and revisions to improve the alertness
management program.

British Airways provides a recent example of program evaluation, conducted to


assess the education section of their Alertness Management program approximately
two years after the introduction of the Alertness Management Manual and trip specific
advice cards. Evaluation involved a non-compulsory survey of flight crewmembers.
Analysis of the survey indicated that satisfaction with the program was generally high
with regard to presentation, readability, and ease of use of the manual. Additionally,
analyses identified two groups of pilots who found the information most valuable: (1)
pilots new to long-haul operations; and (2) those working in a rapidly growing and
evolving long-haul fleet where even experienced crew were frequently presented with
new schedules or destinations for which trip specific guidance on rest and alertness
was particularly valued.

The Association of American Railroads and the Burlington Northern Santa Fe


evaluated an effort to develop a 10-days-on and 5-days-off scheduling agreement for
locomotive crews (Sherry, 2000).10 Several methods were used in the evaluation,
including self-report, objective measures, and performance-based measures of
fatigue. The study involved the pre and post assessment of the engineers who were
assigned the 10/5 schedule. A baseline observation period was conducted during
October 1998, and post testing was conducted in December 1999. The results
indicated that this approach produced a positive change in the lives of the participants
in the 10/5 scheduling program. For the most part, participant’s comments regarding
the effects of the scheduling program were positive. In general, the subjective
impressions of this program indicate that it met with moderate approval by the
participants and reduced fatigue on several subjective measures.

10
Sherry, P. (2000). Fatigue Countermeasures in the Railroad Industry: Past and Current
Developments. Washington, DC: Association of American Railroads.
Fatigue Countermeasure Review Page 4-1

4. Fatigue Countermeasure Review


Introduction
Strategies for reducing fatigue are referred to as “fatigue countermeasures.” This
section discusses 20 fatigue countermeasures. Research indicates that some of
these countermeasures are effective, some are probably effective (but are still being
studied), others require medical supervision, and some simply do not work or have
harmful health effects.

Countermeasures That Work


The countermeasures described in this category are effective as shown by research
data and operational experience. They encompass both the prevention of fatigue by
getting enough sleep and the mitigation of fatigue through countermeasures applied
when you are getting tired. Individual countermeasures will need to be combined,
based on your specific operational circumstances. The countermeasures included in
this category are:
• Adequate Sleep
• Caffeine
• Napping
• Anchor Sleep
• Trip Planning
• Good Sleeping Environment

Countermeasures That Are in the Research Phase


The countermeasures described in this category show promise for reducing fatigue,
but they are some distance from practical application, and are not available for
implementation without the assistance of fatigue research professionals. This is
because of the relative complexity of the procedures, difficulties of practical everyday
implementation, and in some cases, insufficient demonstration that they would be
effective in a real-life environment. The countermeasures included in this category
are:
• Models of Alertness
• Fitness for Duty Testing
• Alertness Maintenance Monitoring

Countermeasures That Require Supervision by a Physician

The countermeasures described in this section either require a prescription by a


physician (e.g., drugs such as stimulants or hypnotics), or require guidance by a
person trained in circadian physiology for best application (e.g., melatonin).
Countermeasures in this category should be used with care, since side effects and
dependencies can develop. Also, there are regulatory prohibitions on drug use for
transportation operators, as well as legal requirements for prescriptions.
Fatigue Countermeasure Review Page 4-2

These countermeasures include:


• Bright Light
• Stimulants
• Sedatives/Hypnotics
• Melatonin

Countermeasures That Are Ineffective, Have Minimal Effects, or Cause Health


Problems
This section discusses a number of approaches that have been advocated as fatigue
countermeasures, but lack scientific data demonstrating their effectiveness (e.g., diet
or aromatherapy), or may cause health problems such as the use of tobacco and/or
nicotine. These approaches are not recommended under any circumstances. Other
countermeasures that have been commonly reported, such as exercise, diet, listening
to the radio, or rolling down the window have minimal or no impact on fatigue, even
though people think they do – these can be especially dangerous since drowsy
people might believe they are OK when in fact they are impaired. The
countermeasures included in this category are:
• Nicotine
• Ventilation and Temperature
• Exercise
• Diet
• Sound
• Odor/Fragrance
• Over-the-Counter Sleep Aids

The following pages have detailed descriptions of each countermeasure, including a


definition, limitations of use, advantages to its use, and considerations in its
application. Each description is also accompanied by selected references that are
provided to give the reader more information about its scientific and operational
aspects.
Fatigue Countermeasure Review Page 4-3

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Fatigue Countermeasure Review Page 4-4

Countermeasures That Work

Adequate Sleep

Definition and Scope


Preventing fatigue by ensuring adequate sleep opportunities,
proper sleep-period timing, and appropriate
accommodations.

Limitations of Use
The limitations associated with this countermeasure tend to involve factors that often
are beyond the control of the individual, such as work shift start times, rotation of
schedule, and location factors that might influence sleep, such as jet lag or the sleep
environment. Additionally, some individuals tend to sacrifice adequate sleep for
purposes of social or family activity; however, these factors involve individual choice
and can be balanced as required.

Advantages to Use
The most effective countermeasure for fatigue is to do as much as possible to prevent
it from occurring in the first place. As the material in the last section of this handbook
suggests, the primary culprit for feeling fatigued is sleep loss. So, whatever can be
done to obtain regular sleep and to prevent sleep loss should be high on the list of
countermeasures. The principal advantage of getting enough sleep is that it will
reduce on-the-job fatigue, thereby reducing the need for other countermeasures.

Things to Consider
The first general strategy for minimizing sleep loss is to establish a routine approach
to obtaining sleep, that allows enough time to obtain sufficient sleep, and ensures
an appropriate sleep environment. This means going to bed at the same time every
night and waking up at the same time every day, allowing for at least eight hours of
rest. This regularity establishes a pattern linked to the circadian rhythm and makes it
easier to go to sleep and wake up. The sleep environment should be quiet, dark, and
not overly warm. Unless the operator is sleep deprived, long naps should be avoided
during the day, as they will interfere with falling asleep during the main sleep period.

Transportation workers often change shift schedules from one week to the next, or
more frequently. This can lead to sleep loss because the body is not adapted to
sleeping at a different time of day. The best approach for reducing sleep loss
associated with a new shift schedule is to start the new shift with no sleep debt – this
means getting at least two nights of unrestricted sleep prior to beginning a new
schedule. If making a radical schedule shift, such as between days and nights, it will
Fatigue Countermeasure Review Page 4-5

also be important to obtain some compensatory sleep prior to the new shift start. For
example, if the schedule starts at midnight Sunday, it would be desirable to get two
full nights of sleep on Friday and Saturday, sleep as long as possible on Sunday
morning, and try to nap for a couple hours before the start of the midnight shift on
Sunday. Napping prior to extended periods of wakefulness will reduce fatigue and
improve alertness.

A third general approach to minimizing sleep loss is to match work schedules to


individual physiology. Morning people (i.e., a “lark”), perform best on work schedules
with early morning starts (e.g., 0700 hours or before). Night people (i.e., an “owl”),
perform best on work schedules that start in the afternoon or night hours. In either
case, it is important that individual physiology be coupled with a sufficient main sleep
period.

Countermeasures to Minimize Sleep Loss:


• Have a regular routine for sleep
• Obtain sufficient sleep
• Ensure your sleep environment is appropriate
• Start new shift schedules with minimal sleep debt
• Obtain compensatory sleep before new schedule
• Match your regular work schedule to your personal
physiology: “lark” or “owl”

References
Mitler, E. A., & Mitler, M. M. (2000). 101 Questions about Sleep and Dreams. Sixth
Edition for the World Wide Web. Available:
http://www.talkaboutsleep.com/basics/questions101/q101_index.htm. Accessed
April 19, 2003.
Zarcone, V. P. (2000). Sleep hygiene. In M. H. Krgyer, T. Roth, & W. C. Dement
(Eds.), Principles and Practice of Sleep Medicine (pp. 657-662). New York: W. B.
Saunders Company.
Fatigue Countermeasure Review Page 4-6

Countermeasures That Work

Caffeine

Definition and Scope


Increasing alertness by consuming caffeine in the form of
coffee, tea, soft drinks, or chocolate; or by taking non-
prescription caffeine tablets.

Limitations of Use
Our bodies gradually build up a tolerance to repeated consumption of high levels of
caffeine (e.g., 5+ cups of coffee per day). A frequent coffee drinker may need a
higher dose of caffeine to obtain the same “boost” effect of the more casual coffee
drinker. Caffeine should be consumed caffeine sparingly, to “save the boost effect”
for when it’s really needed. That is, plan to use caffeine in the middle of the afternoon
dip (1330-1530 hours) or if working through the night, use it after midnight during the
circadian low point (0100-0430 hours).

Advantages to Use
One of the most commonly used fatigue countermeasures is caffeine, usually
obtained through a cup of coffee. Other popular drinks and foods contain a lot of
caffeine, including cola drinks, chocolate, and tea. Numerous medications also
contain caffeine, as do “alertness aids” such as No-Doz and Vivarin. Caffeine is
widely available and can have the advantage of breaking up a tiring work routine, e.g.,
a long, monotonous drive.

Caffeine Content from Various Sources

Percolated Coffee 140 mg / 7 oz


Brewed Coffee 80-135 mg / 7 oz
Red Bull Energy Drink 115 mg / 12 oz
Jolt Cola 72 mg / 12 oz
Coca-Cola 34 mg / 12 oz
Tea 70 mg / 6 oz
Chocolate 5-35 mg / 1 oz
No-Doz or Vivarin 200 mg / tablet
Excedrine 65 mg / tablet
Dristan 30 mg / tablet
Fatigue Countermeasure Review Page 4-7

Caffeine affects your nervous system within 15 to 20 minutes. The effects include a
more rapid heartbeat and increased alertness, and they last for about 4 to 5 hours,
but may last up to 10 hours in especially sensitive individuals.

Things to Consider
It is important to use caffeine only as a short-term way to boost alertness; regular use
can lead to tolerance and various undesirable side effects, including elevated blood
pressure, stomach problems, and insomnia and disrupted sleep if taken too close to
bedtime.

Here are some situations where using caffeine makes sense:


• In the middle of a night shift (especially on the first and second day
of the work week when circadian disruption is most pronounced and
alertness most compromised)
• Mid-afternoon when the post-lunch alertness dip is greater
because you didn’t get enough sleep
• Prior to an early morning commute following a night shift, but not
within 4 hours of going to sleep because it will keep you awake

It is always best to try and reduce fatigue through obtaining enough sleep, but when
this doesn’t happen and you need to boost alertness for a period of several hours,
using caffeine makes sense.

Caffeine will affect sleep and should not be consumed 4 to 5 hours prior to sleep.
Caffeine in the body will make falling asleep more difficult, reduce sleep length, and
disrupt the quality of sleep.

References
Bonnet, M. H. (2000). Sleep deprivation. In M. H. Kryger, T. Roth, & W. C. Dement
(Eds.), Principles and Practice of Sleep Medicine (pp. 53-71). New York: W. B.
Saunders Company.
De Valck, E., & Cluydts, R. (2001). Slow release caffeine as a countermeasure to
driver sleepiness induced by partial sleep deprivation. Journal of Sleep Research,
10, 203-209.
Gillin, J. C., & Drummond, S. P. A. (2000). Medication and substance abuse. In
M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and Practice of Sleep
Medicine (pp. 1176-1195). New York: W. B. Saunders Company.
Fatigue Countermeasure Review Page 4-8

Countermeasures That Work

Napping

Definition and Scope


Using napping as a fatigue countermeasure involves
sleeping for brief periods during work or other awake
periods.

Limitations of Use
Napping should not be used as a substitute for getting enough sleep during your
regular sleep period. Additionally, naps should be limited to a time and duration that
will not interfere with regular sleep periods. Napping too close to bedtime will produce
a boost in alertness that may make it difficult to fall asleep during the regular sleep
period.

Advantages to Use
Taking a nap can help to reduce fatigue and increase alertness on the job, or at other
times. Naps can be effective as a short-term countermeasure to fatigue, or to
compensate for periods when you will need to remain awake for a long time, such as
when you change shifts.

Napping is OK when you need to remain alert but have not obtained enough sleep
because of uncontrollable circumstances. It is important for you to recognize that
because of reduced sleep, you are at risk of being critically fatigued. Some general
situations where napping would be appropriate are:
• You slept for less than 6 hours during your main sleep period
• You were awake for 30 minutes or longer two or more times
• You felt as if you were continually drifting in and out of sleep
• You felt much more tired than usual upon awakening from your
regular sleep period

Things to Consider
When using napping as a countermeasure, it is important to think about the following:
• Where to take the nap?
• When to take the nap?
• How long to nap?

These questions will have different answers depending on the nature of your work. If
you are a merchant mariner, your sleeping quarters are very likely close to your work
Fatigue Countermeasure Review Page 4-9

area, making the issue of where to nap easy. Truckers may have sleeper berths, but
need an off-road location to use them. Timing and duration are other critical elements
of the nap countermeasure that need consideration in advance – if you wait until you
are critically fatigued you are already in the danger zone.

Taking a nap should be timed to obtain the maximum benefit. This will vary
depending on your circumstances, but in general the following guidelines are
applicable:
• Take 10-12 minute “power naps” almost anytime as needed, as
they can help refresh you for a short period of time.
• Napping for longer periods (2+ hours) prior to the start of a night
shift can restore energy levels and is very beneficial.
• If you are day-oriented and not sleep deprived, avoid napping
during the hours of 1000 to 1200 when alertness is usually high.
• Schedule a nap during the mid-afternoon (1300 to 1500 hours)
when alertness is low (see section 5-2 for additional detail).
• Naps during work periods should be limited to 45 minutes to
minimize waking from deep sleep (stages 3 and 4) where it can take more
than 30 minutes to become fully alert.
• Allow 15-30 minutes after a nap to become fully alert. The deeper
the sleep the longer the period needed to become fully alert.
• Napping is part of a continuous, non-split shift duty period, and
should not be used to extend the duty period.
• Use an alarm clock to assist in waking up

There may be times when you feel overwhelmed by sleepiness despite “strategic
naps” or a sufficient sleep period before work. In this case, you should take an
“emergency nap” of 15 to 30 minutes as soon as your work activity permits. If you are
on duty, you will need to use other countermeasures until you get to a good time or
place for a break.

References
Bonnet, M. H., & Arand, D. L. (1994). Impact of naps and caffeine on extended
nocturnal performance. Physiology and Behavior, 56, 103-109.
Dinges, D. F., Connell, L. J., Rosekind, M. R., Gillen, K. A., Kribbs, N. B., &
Graeber, R. C. (1991). Effects of cockpit naps and 24-hour layovers on sleep
debt in long-haul transmeridian flight crews. Sleep Research, 20, 406.
Macchi, M. M., Boulos, Z., Ranney, T., Simmons, L., & Campbell, S. S. (2000).
Effects of an afternoon nap on nighttime alertness and performance in
long-haul drivers. Accident Analysis and Prevention, 34, 825-834.
Fatigue Countermeasure Review Page 4-10

Countermeasures That Work

Anchor Sleep

Definition and Scope


Anchor sleep refers to a regular sleep period of at least four
hours duration, obtained at the same time each day. The
anchor sleep period is supplemented by an additional sleep
period taken when the schedule allows.

Limitations of Use
Anchor sleep should be used as a coping mechanism for situations where you cannot
get a full eight hours of sleep, but not as a routine. While split sleep periods may give
you a sufficient amount on a short-term basis, getting your full sleep allotment in a
single episode is preferred.

Advantages to Use
Some work schedules do not allow you to get a full eight hours of sleep at the same
time period every day. Examples include long-haul truck driving and maritime
operations. In order to effectively cope with schedules like these, you should arrange
to get at least four hours of sleep at the same time every day; additional sleep can be
obtained as your schedule permits.

Anchor sleep periods have the advantage of stabilizing your circadian rhythm to a
24-hour period, so that you do not constantly feel “out of synch.” You can time the
anchor sleep period so that your circadian rhythm high and low points correspond to
your work and sleep periods.

Things to Consider
Anchor sleep is not a substitute for getting a full eight hours during any 24-hour
period. Instead, it is a coping mechanism meant to keep your circadian rhythm
synchronized to your daily schedule, by allowing you to sleep for a period of time
when you can sleep. It is important to supplement anchor sleep with supplemental
naps that are sufficient to give you the complete sleep allotment that you need on a
daily basis. This countermeasure anchors the sleep cycle.

Research data indicate that it is important to have the anchor sleep period occur at a
constant time every day, so if you are going to use this approach, make sure your
schedule allows this. You will also need to consider when you will take your
supplemental sleep periods, since it may be tempting to simply “push through” any
Fatigue Countermeasure Review Page 4-11

low point in the day thinking that you have got just enough sleep to keep you going.
This will not work and can endanger yourself and others.

Meals should be taken at the times you normally eat. When you take your
supplemental sleep, make sure that you don’t get it so close to your anchor sleep
period that you interfere with it. You should also be careful about caffeine
consumption when using this routine, because you may be tempted to drink coffee or
other caffeinated beverages near the times you will be going to sleep.

References
Minors, D. S., & Waterhouse, J. M. (1981). Anchor sleep as a synchronizer of
rhythms on abnormal routines. International Journal of Chronobiology, 7, 165-
188.
Minors, D. S., & Waterhouse, J. M. (1983). Does “anchor sleep” entrain circadian
rhythms? Evidence from constant routine studies. Journal of Physiology, 345,
451-467.
Fatigue Countermeasure Review Page 4-12

Countermeasures That Work

Trip Planning

Definition and Scope


Use knowledge of the length and structure of your trip
to plan rest intervals prior to and during the trip.

Limitations of Use
The limitations on trip planning involve factors that are often outside of your
immediate control, such as when your work shift starts, the availability of rest areas,
and the pace of your operations. In general, though, trip planning is an effective
approach to starting work more refreshed, and alleviating fatigue while on the job.

Advantages to Use
The primary advantage of trip planning is that you can anticipate those times at which
you will be feeling fatigued, and do something about it before it lowers your
performance to unsafe levels. It also provides you with some structure along your
route so that you won’t be tempted to overextend yourself. Proper use of trip planning
and the associated rest intervals will keep you from getting so fatigued that you may
have an accident, and also allows you to plan where and when to sleep for your main
sleep period during multiple day trips.

Things to Consider
Trip planning can be considered both a preventive countermeasure, as well as an
operational approach. Trip planning would involve ensuring that you are properly
rested prior to starting a trip – this would entail getting enough sleep during your main
sleep period, and taking a nap prior to a trip start time that occurs during your normal
sleep period. Many mariners, for example, take a fairly long nap prior to docking in
the middle of the night. Similarly, airplane pilots might nap prior to a red-eye flight.

The operational approach to trip planning involves determining where and when you
might be able to rest during transit. This will vary substantially by transportation
mode, but in general should involve a safe, quiet, and comfortable place where you
can nap for 15 to 45 minutes.

References
Rosekind, M. R., Smith, R. M., Miller, D. L., Co, E. L., Gregory, K. B., Webbon, L. L.,
Gander, P. H., & Lebacqz, J. V. (December 1995). Alertness management:
Strategic naps in operational settings. Journal of Sleep Research, 4(S2), 62-66.
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Countermeasures That Work

Good Sleeping Environment

Definition and Scope


A good sleeping environment sets the stage for restorative
sleep. Although most people can get used to almost any
sleep environment, especially when they are exhausted,
certain characteristics of where you sleep can enhance or
compromise how restorative a rest period is.

Limitations of Use
There may be practical limitations to controlling the physical elements of the sleep
environment, especially when traveling. For example, some hotels do not provide
room-darkening shades, or outside traffic noise may be unavoidable. However, an
individual can prepare for some of these factors by carrying earplugs and eyeshades.
It is also important to not invest too much psychologically in the need for certain sleep
environment characteristics because this can lead to stress-induced insomnia.

Advantages to Use
The principal advantage to using this countermeasure is that an individual can adapt
their sleep environment to meet individual needs, and have a continuing positive
effect on sleep quality.

Things to Consider
To ensure that sleep is restorative, sleeping environments must be quiet, dark, and
comfortable.

To ensure a quiet environment, the individual should remove any noise sources,
especially those that are unpredictable (e.g., pets in the bedroom). Use of earplugs to
reduce traffic noise or other external sounds helps many people, as well as the use of
a constant low-level noise source such as a fan.

The amount of light in a sleeping area can be reduced by using black-out shades,
heavy dark fabric for curtains, or “hurricane shutters” over windows. Some people
also use eyeshades in areas where there is substantial light leakage.

Comfort in the sleeping environment is related to the quality of the bed, and the
temperature. The bed and pillows should be of appropriate firmness for personal
comfort, and the temperature not too warm or too cold.

Two additional environmental recommendations include: orient the clock face away
from you so as not to worry about the times especially when having difficulty falling
asleep, and use your sleeping area only for sleeping – not other arousing activities
such as work or watching TV and videos.

References
Zarcone, V. P. (2000). Sleep hygiene. In M. H. Krgyer, T. Roth, & W. C. Dement
(Eds.), Principles and Practice of Sleep Medicine (pp. 657-662). New York: W. B.
Saunders Company.
Fatigue Countermeasure Review Page 4-16

Countermeasures That Are in the Research Phase

Models of Alertness

Definition and Scope


Using knowledge of the physiological processes
controlling alertness to predict your level of alertness
on the job.

Limitations of Use
Alertness models are only available to transport workers as “rules of thumb.” The
research community has not yet produced software tools that can be used with
precision by the layman. Also, there are many other variables contributing to
momentary alertness levels, such as stimulation level, other countermeasures
employed, and individual differences in sleep needs. So, model predictions should be
used as guidelines rather than absolute predictions of alertness. In addition, models
need to be validated for each particular use. Models developed for one application
are all too often generalized for other applications without being validated for that use.

Advantages to Use
Research indicates that level of alertness at any particular point in time is controlled
by three basic factors: (1) circadian rhythm (see section 5-2), (2) length of last sleep
period, and (3) length of time awake. Specific alertness values can be predicted from
knowing where an individual is in their circadian phase, how long they slept during
their last sleep period, and how long it has been since they woke-up. The nature of
this model conforms to biology and common sense: an individual is naturally sleepy
toward the late evening hours, sleeping for 8 hours recovers alertness, and alertness
decreases the longer an individual is awake.

Although “plug-in” models to predict alertness are not available at this time, it is
possible to use the general nature of these models to predict how an individual is
likely to be feeling during a schedule change. For example, if you are going to switch
from day to night shifts, it is likely that you will wake up on the first day of your night
shift at your usual time, e.g., 0700 hours. Your alertness profile will reflect this, and
throughout the day your circadian sleepiness process will increase, so that by the
time you go to work at 2300 hours, you will be ready to go to sleep. As you stay
awake throughout the night, your alertness will decrease as it follows the circadian
rhythm process; there will be no increased value on your sleep recovery process to
balance that out.

As you adjust to this new shift over a week, your physiological processes will
eventually adapt, so that your alertness level will increase as you are on the job.
Using knowledge of how your alertness is affected by your internal physiology will
Fatigue Countermeasure Review Page 4-17

help you to anticipate how you will feel at certain points in time, and to think about
other potential countermeasures you might use, such as caffeine or a nap.

Things to Consider
Alertness models are best used to estimate periods of reduced alertness so that
specific countermeasure can be identified and used. Additionally, alertness profiles
from the models can be used to design work schedules.

References
Borbeley, A. A., & Achermann, P. (1999). Sleep homeostasis and models of sleep
regulation. Journal of Biological Rhythms, 14, 557-568.
Dawson, D., & Fletcher, A. (2001). A quantitative model of work-related fatigue:
background and definition. Ergonomics, 44(2), 144-163.
Folkard, S., Akerstedt, T., Macdonald, I., Tucker, P., & Spencer, M. B. (1999).
Beyond the three-process model of alertness: Estimating phase, time on shift and
successive night effects. Journal of Biological Rhythms, 14(6), 579-587.
Hursh, S. R. (2001). Fatigue and alertness management using FAST™ (On-line).
Available: http://hprct.dom.com/2001/presentations/hursh/Default.htm.
Accessed April 17, 2003.
Fatigue Countermeasure Review Page 4-18

Countermeasures That Are in the Research Phase

Fitness for Duty Testing

Definition and Scope


Fitness-for-duty tests determine if a transportation operator
or employee is fit to perform their job at the moment of
testing. This means: (1) “testing” when the worker shows up
at the workplace to begin an assigned work shift; (2)
periodically testing a worker in the middle of a work shift to
determine if he/she is still performing with a satisfactory level
of alertness; or (3) testing prior to being permitted to work an
additional work shift, or doing overtime.

Limitations of Use
A growing number of fitness-for-duty tests are becoming more portable, and now are
commercially available. However, many such devices have not been “validated” as
fitness-for-duty tests, even though they might be advertised as such. These tests are
still in the research stage and must overcome a variety of issues related to practical
implementation. For example, most fitness-for-duty tests do not reliably predict
whether a worker will perform adequately some number of hours (e.g., 3 to 7 hours)
into the future, after passing the “fitness now” test. Additionally, there is no
agreement on an acceptable performance level.

Advantages to Use
Fitness-for-duty testing may detect a worker who reports to work already sleep
deprived. It attempts to predict “how ready a worker is to perform” within acceptable
levels of cognitive alertness, and to predict if good performance can be sustained
over the duration of the ensuing work shift. Fitness-for-duty testing is an idea similar
to conducting a “drug or alcohol test” to determine if a worker is ready to perform the
job.

Things to Consider
Fitness-for-duty tests generally employ short tasks to measure a worker’s abilities that
would be affected by fatigue. These include:
• Reaction time
• Eye-hand coordination tasks
• Tracking
• Short term memory
• Involuntary eye reflexes such as pupil diameter
• Speed and amplitude of pupil response and saccadic velocity
Fatigue Countermeasure Review Page 4-19

Having one or more fitness test stations set-up at transportation terminals might
permit periodic employee fitness testing before workers begin a work shift.

References
Dinges, D. F., & Mallis, M. M. (1998). Managing fatigue by drowsiness detection:
Can technological promises be realized? In L. R. Hartley (Ed.), Managing fatigue
in transportation. Proceedings of the Third International Conference on Fatigue
and Transportation, Freemantle, Western Australia. Oxford: Elsevier Science,
Ltd.
Hartley, L. R., Horberry, T., Mabbott, N., & Krueger, G. P. (September 2000).
Review of fatigue detection and prediction technologies: Technical report.
Melbourne: Australian National Road Transport Commission (NRTC). Available:
www.nrtc.gov.au/publications/reports2000. Accessed April 17, 2003.
Horberry, T., Hartley, L. R., Mabbott, N., & Krueger, G. P. (2001). Fatigue detection
technologies for trucks and commercial vehicles: Possibilities and potential
pitfalls. Business Briefing: Global Truck and Commercial Vehicle Technology,
January 2001, 58-63.
Mallis, M. M. (June 1999). Evaluation of techniques for drowsiness detection:
Experiment on performance-based validation of fatigue-tracking technologies
(Doctoral Thesis, Drexel University, Philadelphia, PA., 1999). (Available through
Dissertation Abstracts).
Fatigue Countermeasure Review Page 4-20

Countermeasures That Are in the Research Phase

Alertness Monitoring

Definition and Scope


Alertness monitoring involves tracking the performance
or physiological measures of vehicle operators to
determine if they are approaching drowsiness or
impairment. Vehicle-based technologies compare
current operator performance on such factors as driver
steering-wheel variability, vehicle acceleration, speed
variability, braking, gear changing, lane deviation,
distances between vehicles, and route navigation
against the operator’s normal performance. Operator
status monitors often seek to measure and record, in near real time, some physical or
physiological features of the operator’s eyes, face, head, heart, brain electrical
activity, muscular activity, reaction time, etc.

Limitations of Use
Virtually all of the in-vehicle and physiological monitoring devices are in the research
stage. While some devices may be commercially available (from very small and
specialized companies), there is not yet sufficient evidence about their reliability and
validity to warrant routine use.

Some of the questions that need to be answered include:


• What is “normal” or safety critical “abnormal” variability for these
measures?
• What constitutes acceptable performance for equipment operators
within a particular transportation mode (e.g., pilots, transit operators, truck
drivers, etc.)?
• Could a perfectly safe operator be classified as “unacceptable” on
occasions (e.g., score a false positive)?
• What measures are best for providing an “early warning” so that
operators have not already gone too far into the impairment zone?

Suitable answers to these and other questions must be developed for each
monitoring technology and for equipment operators in each mode of transportation.

Advantages to Use
The utility of either type of in-vehicle monitors is the “self-monitoring and self-
management information” concerning the operator’s level of alertness or fatigue.
Relatively unobtrusive instrumentation can continuously provide the individual with a
personal monitor of actual performance in controlling the vehicle, or offer a personal
physiologically based alertness index. If the measures exceed criteria for degraded
performance, the monitoring systems warns the operator by way of an alerting
Fatigue Countermeasure Review Page 4-21

mechanism (e.g., visual, auditory, vibratory signals) that they look or are acting
drowsy at the controls.

Once you gain confidence the technologies can be of assistance in personal alertness
monitoring, you can incorporate these features into a set of personal alertness and
fatigue management practices to help ensure safe operation of the vehicle, and
lessen the likelihood of falling asleep at the controls.

Things to Consider
Integrating combinations of several different monitoring technologies, employing both
vehicle performance and operator physiological status indicators, offers the best
chance of keeping a transportation equipment operator informed of his/her alertness
status and impending fatigue effects on safe vehicle control. A growing number of in-
vehicle and operator status monitoring systems are being tested and evaluated
commercially and through government sponsored field-testing. When effectiveness in
terms of reliability, sensitivity, and validity is attained through formal validation testing,
it may prove worthwhile to incorporate that into corporate operator fatigue
management programs. Computerized micro-miniaturization of many of these
devices will make them affordable.

Developing operator trust in the systems will be an important element of alertness


monitoring technologies.

References
Dinges, D. F., & Mallis, M. M. (1998). Managing fatigue by drowsiness detection:
Can technological promises be realized? In L. R. Hartley (Ed.), Managing Fatigue
in Transportation. Proceedings of the Third International Conference on Fatigue
and Transportation, Freemantle, Western Australia. Oxford: Elsevier Science,
Ltd.
Hartley, L. R., Horberry, T., Mabbott, N., & Krueger, G. P. (September 2000).
Review of fatigue detection and prediction technologies: Technical report.
Melbourne: Australian National Road Transport Commission (NRTC). Available:
www.nrtc.gov.au/publications/reports2000. Accessed April 17, 2003.
Horberry, T., Hartley, L. R., Mabbott, N., & Krueger, G. P. (2001). Fatigue detection
technologies for trucks and commercial vehicles: Possibilities and potential
pitfalls. Business Briefing: Global Truck and Commercial Vehicle Technology,
January 2001, 58-63.
Mallis, M. M. (June 1999). Evaluation of techniques for drowsiness detection:
Experiment on performance-based validation of fatigue-tracking technologies
(Doctoral Thesis, Drexel University, Philadelphia, PA., 1999). (Available through
Dissertation Abstracts).
Fatigue Countermeasure Review Page 4-22

Countermeasures That Require


Supervision by a Physician

Bright Light

Definition and Scope


The use of bright light as an operational fatigue
countermeasure refers to timing the exposure to
outside or bright indoor light in order to shift the
circadian rhythm to correspond to a new work
schedule, or to enhance alertness.

Limitations of Use
Use of light exposure for resetting the circadian rhythm is a complex undertaking, and
should be guided by a person knowledgeable in circadian physiology. Additionally,
the benefits of resetting the circadian rhythm can be maintained only through fairly
rigid adherence to the procedure, and ensuring that other time cues (e.g., daylight)
are minimized. For some workers, this countermeasure may not be feasible because
of the need to maintain low light levels in the work environment (e.g., aircraft cockpits
or ship bridges).

Use of indoor lighting levels to increase alertness may not be feasible in some work
environments where night vision is required. In addition, it is necessary to minimize
the exposure to light prior to bedtime so that the individual is not too alert to sleep.

Advantages to Use
One reason that shift workers are sleep deprived is that their circadian rhythms never
adjust from that of a day-oriented worker because of the constant exposure to time
cues such as bright light and social activity. Bright light can be used to increase
alertness at times when circadian rhythms would otherwise be at a low point and the
individual would be feeling sleepy, such as in the middle of a night shift.

By using bright light exposure to shift circadian rhythms to work schedule


requirements, individuals will get more sleep and feel more alert when they are on
the job. This countermeasure can be particularly useful for pilots and other transport
workers who rapidly shift through multiple time zones, and for those who work on a
forward rotating schedule that changes by one shift each rotation (e.g., day shift,
afternoon, night). There are also approaches that can be used for permanent night
shift workers.

Things to Consider
In order to shift the circadian rhythm using bright light and controlled dark exposure,
an individual needs to determine whether he/she wants to advance or delay his/her
rhythm. Advancing the rhythm means shifting it so that the low point in the daily cycle
(as measured by body temperature) occurs earlier, whereas delaying the rhythm
Fatigue Countermeasure Review Page 4-23

means shifting it so the low point occurs later. Advancing the rhythm will make the
day seem shorter – the individual will feel sleepy earlier, while delaying the rhythm will
extend the day and the individual will be able to stay up later.

Advancing the circadian rhythm allows an individual to adjust to eastbound travel, for
example, or to an earlier schedule. Delaying the circadian rhythm allows adjustment
to westbound travel, or a later schedule. In general, if an individual is exposed to light
following the low point in his/her rhythm it will advance, making it easier to go to sleep
earlier and wake up earlier. In contrast, if an individual is exposed to light before
his/her low temperature point, the rhythm will delay, making it easier to work and
sleep later. In practice this means exposure to light during the first part of a night shift
to delay the rhythm, or exposure to light prior to normal wake up time, if an individual
is a day worker, to advance the rhythm.

The light exposure we are talking about is in the range of 3000 to 10000 lux – much
beyond that obtained simply from indoor lights. Special equipment is required to
generate this level of illumination, and some evidence suggests that the green
wavelength is especially effective. Using light exposure for several hours over a
period of several days is usually most effective in shifting the circadian rhythm,
although periods as short as 30 minutes have been shown to have an effect.

In addition to light exposure, it is also important to control the timing of darkness.


This is especially true for those workers who may be traveling between work and
home in the bright morning sun. In these cases, it is important to minimize exposure
to the sunlight by wearing dark glasses (special goggles are recommended), and to
ensure that your sleeping quarters are blacked out.

Exposure to indoor-lighting levels for several hours during the early part of the night
(e.g., prior to bedtime) can also promote alertness, and with greater alertness at
higher light intensities. This countermeasure can be used in addition to light
exposure, or by itself to shift your circadian rhythm. This is a particularly good
countermeasure to use if you have the flexibility in your work environment to control
the lighting level.

References
Cajochen, C., Zeitzer, J. M., Czeisler, C. A., & Dijk, D. J. (2000). Dose-response
relationship for light intensity and ocular and electroencephalographic correlates
of human alertness. Behavioural Brain Research, 115, 75-83.
Eastman, C. I., Boulos, Z., Terman, M., Campbell, S. S., Dijk, D. J., & Lewy, A. J.
(1995). Light treatment for sleep disorders: Consensus report. VI. Shift work.
Journal of Biological Rhythms, 10, 157-164.
Wright, H. R., & Lack, L. C. (2001). Effect of light wavelength on suppression and
phase delay of the melatonin rhythm. Chronobiology International, 18, 801-808.
Fatigue Countermeasure Review Page 4-24

Countermeasures That Require


Supervision by a Physician

Stimulants

Definition and Scope


The use of synthetic or natural drugs to reduce the
effects of sleep loss and enhance alertness.

Limitations of Use
Even under the guidance of a physician, stimulants can have unwanted and
dangerous side effects, including changes in blood pressure and pulse, headaches,
irritability, appetite loss, insomnia, nervousness, talkativeness, and sweating.
Extreme reactions include hallucinations and paranoid psychosis.

Prescription stimulants are not generally permitted in operation of public


transportation vehicles in the U.S. and many other industrialized nations.
Randomized drug testing is regularly carried out to cut down on the usage of most
known stimulants, at the threat of loss of job.

Stimulants have a high potential for addiction and abuse because of the rapid
euphoria that results from high doses. This can lead to a cycle of binging and
crashing, and long-term abuse can lead to mental and behavioral disorders.

Finally, possession and use of controlled substances without a proper physician’s


prescription is illegal, and could result in fines and jail time.

Advantages to Use
Stimulants exert a physiological effect on your nervous system so that the effects of
sleep loss can be temporarily reduced. Caffeine (discussed in a separate entry) is an
example of a stimulant – one that does not require a prescription, and that does not
have adverse side effects unless consumed in very large quantities.

Stimulants are particularly useful to the small population of individuals who suffer from
narcolepsy or other debilitating sleep disorders. Military personnel sometimes use
stimulants during sustained operations, although this practice has recently been
questioned.

The effects of prescription stimulants such as dextroamphetamine and modafinil are


clear-cut – alertness is increased and performance is enhanced, relative to sleep-
deprived individuals. These effects are also observed with a number of over-the-
counter decongestants containing pseudoephedrine, and herbal stimulants such as
ephedra.
Fatigue Countermeasure Review Page 4-25

Things to Consider

Synthetic stimulants such as amphetamine and modafinil are controlled substances


and should only be used under the guidance of a physician for treatment of a
specifically debilitating sleep disorder.

Herbal stimulants are unregulated, and the effects of many are unknown because of
lack of proper evaluation. However, it is known that ephedra in particular is
associated with heart attack and stroke, and is likely to soon be controlled. You
should consider all herbal stimulants as unproven and a safety hazard.
Decongestants are not designed for increasing alertness – this happens as a side
effect, along with increased drying of mucous membranes.

Following is a list of medically prescribed stimulants:


• Methylphenidate
• Dextroamphetamine
• Methamphetamine
• Pemoline
• Mazindol
• Levo-amphetamine
• Fencamfamin
• Modafinil

References
Babkoff, H., & Krueger, G. P. (1992). Use of stimulants to ameliorate the effects of
sleep loss during sustained performance (DTIC No. AD:a259-712). Military
Psychology, 4, 191-205.
Gyllenhaal, C., Merritt, S. L., Peterson, S. D., Block, K. I., & Gochenour, T. (2000).
Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep
Medicine Reviews, 4, 229-251.
Mitler, M., & Aldrich, M. S. (2000). Stimulants: Efficacy and adverse effects. In
M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and Practice of Sleep
Medicine (pp. 429-440). New York: W. B. Saunders Company.
Fatigue Countermeasure Review Page 4-26

Countermeasures That Require


Supervision by a Physician

Sedatives/Hypnotics

Definition and Scope


The use of synthetic or natural drugs to promote sleep
when schedule changes interfere with falling asleep.

Limitations of Use
Depending on the specific type of drug class, there are changes in the nature of an
individual’s sleep although the significance of these changes is unknown. The overall
amount of sleep does not change.

It is possible to develop a dependence on hypnotics if used for a long period of time,


and there is often a “rebound insomnia” in which sleep is slightly worse for 1 or 2
nights after discontinuing the drug even if used for only short periods of time.

If the drug is a particularly long-acting one, or if the individual has high sensitivity,
there may be a “hangover” effect the next day where the individual may feel sluggish.

Advantages to Use
If a worker has a sudden change of schedule that interferes with their ability to go to
sleep, there are drugs and herbal substances that can be used to promote sleep.
Hypnotic drugs such as Halcion and Restoril are part of a class of drugs that are
useful for inducing sleep. These drugs reduce the amount of time required to fall
asleep, improve ability to stay asleep, and can maintain sleep for 7 to 8 hours.

Herbal remedies such as Valerian root, chamomile, kava, and lavender are promoted
as sleep aids, but the evidence for their effectiveness is much less clear.

Sedatives and hypnotics have the advantage of being applicable to a number of


situations that might interfere with sleep, such as shift changes, jet lag, or stress-
related short-term insomnia. The drugs can help to alleviate these short-term
problems and be discontinued to preclude the risk of dependency.

Following is a list of the most well-known non-barbiturate hypnotic sedatives by their


trade name:
• Ambien
• Dalmane
• Doral
• Halcion
Fatigue Countermeasure Review Page 4-27

• ProSom
• Restoril
• Sonata

Things to Consider
If you want to use hypnotics to help you get to sleep, you should make sure you are
doing everything else possible before resorting to drug treatment. This includes
ensuring that your sleep environment is appropriate, and that caffeine or exercise is
not interfering with sleeping.

You should use hypnotics only by prescription from a physician, and only for as long
as necessary to “get over the hump” of sleeplessness, and this should be the lowest
clinically indicated dose for as short a time as possible. You should consider the
hypnotics as an aid to achieve sleep schedule re-adjustment, instead of a necessity
for getting to sleep.

References
Gyllenhaal, C. Merritt, S. L., Peterson, S. D., Block, K. I., & Gochenour, T. (2000).
Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep
Medicine Reviews, 4, 229-251.
Roehrs, T., & Roth, T. (2000). Hypnotics: Efficacy and adverse effects. In
M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and Practice of Sleep
Medicine (pp. 414-418). New York: W. B. Saunders Company.
Fatigue Countermeasure Review Page 4-28

Countermeasures That Require


Supervision by a Physician

Melatonin

Definition and Scope


Melatonin is a hormone produced by the pineal gland in
the brain, which increases during the evening and night
hours. Synthetic or natural melatonin is used to induce
sleepiness and may adjust the circadian rhythm to new
schedules.

Limitations of Use
The Food and Drug Administration does not regulate the sale of melatonin, so the
quality of products available in health food stores and other outlets is uncertain.

Because use of melatonin can cause drowsiness, it should not be taken if an


individual intends to drive or engage in other complex or potentially dangerous
activity.

The sleep inducing effects of melatonin are temporary, so while an individual may be
able to get to sleep at an unusual time by using melatonin, they may not be able to
stay asleep for as long as desired. Additionally, various side effects of melatonin
have been reported, including worsened fatigue, depression, coronary artery
constriction (possibly increasing heart attack risk), and possible effects on fertility.
For these reasons, it is important to only use melatonin under the guidance of a
properly trained physician.

Advantages to Use
Melatonin in small doses (0.3 to 5 mg) has rapid sleep inducing effects, and lowers
alertness and body temperature following administration. When combined with
proper timing and light exposure, melatonin can help to adjust the circadian rhythm to
a new schedule, and reduce the effects of fatigue and jet lag.

Things to Consider
The timing of melatonin is an important factor – it needs to be taken in the proper
relationship to the body’s biological rhythm in order to achieve the desired effect. It is
easiest to use melatonin to advance the rhythm, that is, to speed up an individual’s
body clock so that they will go to sleep earlier and get up earlier. In order to do this,
melatonin should be taken well before the low point of an individual’s circadian
rhythm. For example, air travelers from the west coast who need to adapt to East
Coast time might take melatonin around 2100 Eastern Standard Time in order to
promote sleep at a time when they would otherwise be wide-awake.
Fatigue Countermeasure Review Page 4-29

Using melatonin to delay the circadian rhythm is somewhat more complicated


because of the interaction with daylight, which is a much more powerful adaptation
mechanism.

In either case, the use of melatonin should be guided by a physician who specializes
in circadian physiology and the use of melatonin for treating circadian rhythm
adaptation disorders.

References
Arendt, J., Stone, B., & Skene, D. (2000). Jet lag and sleep disruption. In
M. H. Krgyer, T. Roth, & W. C. Dement (Eds.), Principles and Practice of Sleep
Medicine (pp. 591-599). New York: W. B. Saunders Company.
Burgess, H. J., Sharkey, K. M., & Eastman, C. I. (2001). Bright light, dark, and
melatonin can promote circadian adaptation in night shift workers. Sleep
Medicine Reviews, 6, 407-420.
The National Sleep Foundation. (1997). Melatonin: The facts (On-line).
Available: http://www.sleepfoundation.org/publications/melatoninthefact.html.
Accessed April 17, 2003.
Fatigue Countermeasure Review Page 4-30

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems

Nicotine

Definition and Scope


Use of nicotine through smoking, nicotine patches, or other
means to maintain alertness.

Limitations of Use
The adverse health effects of nicotine, especially from tobacco use, far outweigh the
small alerting effects obtained. Additionally, nicotine reduces the quality of sleep
when consumed within several hours of bedtime. Because of the addictive nature of
nicotine, the detrimental health effects, and its interference with sleep, we recommend
against any use of this substance.

Advantages to Use
Nicotine is a stimulant that has effects on performance and mood similar to that of
caffeine; that is, it enhances alertness for a period of time following consumption.

Things to Consider
The alerting effects of nicotine use occur relatively quickly compared to caffeine,
which takes approximately 30 minutes to enhance alertness. The duration of nicotine
in the bloodstream is approximately 2 hours. This should not be interpreted as
meaning that the alerting effect will last 2 hours, because the effects of nicotine are
quite dose dependent, with large individual differences in reaction depending on how
frequently nicotine is used.

References
Griesar, W. S., Zajdel, D. P., & Oken, B. S. (2002). Nicotine effects on alertness and
spatial attention in non-smokers. Nicotine and Tobacco Research, 4, 185-194.
National Institute of Drug Abuse. (July 1998). Facts about nicotine and tobacco
products (On-line). Available:
http://www.drugabuse.gov/NIDA_Notes/NNVol13N3/tearoff.html.
Accessed April 30, 2003.
Zarcone, V. P. (2000). Sleep Hygiene. In M. H. Krgyer, T. Roth, & W. C. Dement
(Eds.), Principles and Practice of Sleep Medicine (pp. 657-662). New York: W. B.
Saunders Company.
Fatigue Countermeasure Review Page 4-31

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems

Ventilation and Temperature

Definition and Scope


Changing airflow and temperature in the surrounding
environment to increase alertness.

Limitations of Use
While there may be a brief effect of lowering the surrounding temperature or
increasing airflow, research data suggest that the impact is very short, and not likely
to increase alertness for longer than a few moments. So, if an individual is feeling
sleepy, it is best to use another countermeasure.

Advantages to Use
Altering the airflow and temperature in the surrounding environment is fairly easy for
most transportation operators, through control of air conditioning or increasing fresh
air by opening a window.

Things to Consider
It is important to ensure that the air quality in the immediate operational environment
is good, since fatigue is one of the symptoms often associated with impurities in the
air. The fatigue that results from impurities is a physiological reaction to reduced
oxygen, and an indication that the environment should be changed. For
transportation operators, these impurities might result from improperly ventilated
exhaust systems or toxic cargo that is leaking.

Temperature tends to affect alertness indirectly, by increasing the overall comfort


level. So, if an individual is inclined to feel sleepy anyway, a warm environment may
increase those feelings. However, the opposite is not true – there is little benefit to
opening a window or lowering the temperature if an individual is already fatigued.

References
Mavjee, V., & Horne, J. A. (1994). Boredom effects on sleepiness/alertness in the
early afternoon vs. early evening and interactions with warm ambient temperature.
British Journal of Psychology, 85, 317-333.
Fatigue Countermeasure Review Page 4-32

Reyner, L. A., & Horne, J. A. (1998). Evaluation of “in-car” countermeasures to


sleepiness: Cold air and radio. Sleep, 21, 46-50.
Fatigue Countermeasure Review Page 4-33

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems

Exercise

Definition and Scope


The use of physical exercise to shift circadian rhythms,
increase alertness on the job, and to promote good
sleep.

Limitations of Use
While exercise will promote health and improve an individual’s sleep, it does not
permit them to cut back on primary sleep. Exercise can reduce immediate feelings of
fatigue resulting from schedule changes and sleep deprivation, but that feeling only
lasts for about 30 minutes. The effects of exercise on job performance are complex,
and tend to wear off quickly, possibly even making performance worse in the
afternoon. So, while an individual may feel better after exercising during a sleepy
period on the job, they are still fatigued and should be aware that performance is
likely to be compromised.

Do not exercise too close to bedtime, because increases in body temperature and
alertness will make it difficult to go to sleep.

Advantages to Use
Physical exercise has the principal benefit of improving overall cardiovascular health
and muscle tone. Additionally, regular exercise improves sleep – individual’s fall
asleep quicker and sleep more soundly.

Research suggests that physical activity can shift the circadian rhythm forward or
backward depending on the timing of the exercise. It is likely that changing the timing
of regular physical exercise, along with other time cues such as exposure to light and
timing of meals can help shift circadian rhythm to a new work schedule.

Physical exercise can also be used to reduce the feeling of fatigue resulting from not
getting enough sleep. Research indicates that brief periods of exercise can reduce
feelings of sleepiness, although job performance does not improve. In rested
individuals, a morning exercise break may improve alertness and driving performance
for a brief period afterwards.

Things to Consider
The health benefits of regular physical exercise are clearly established, and
individuals should consider initiating a regular program of exercise or maintaining
Fatigue Countermeasure Review Page 4-34

what they are already doing. If they work irregular hours or in situations that limit
what they can do (e.g., no ready access to a gym, or darkness), planning ahead and
the use of alternative activities such as walking can be used to maintain a healthy
activity level.

Regular exercise will contribute to feelings of increased energy, by helping develop


stamina and improving your sleep. It should be a regular part of a healthy lifestyle as
well as a primary fatigue countermeasure.

Because exercise can move the circadian rhythm, the timing of exercise is very
important. If an individual wants to delay sleep, exercising just prior to bedtime will
tend to delay their rhythm. Alternatively, if an individual wants to go to sleep earlier,
as in east-west travel, exercising several hours before they intend to go to bed will
advance their rhythm.

References
Baehr, E. K., Fogg, L. F., & Eastman, C. I. (1999). Intermittent bright light and
exercise to entrain human circadian rhythms to night work. American Journal of
Physiology, 277, R1598-R1604.
Bonnet, M. H. (2000). Sleep Deprivation. In M. H. Kryger, T. Roth, & W. C. Dement
(Eds.), Principles and Practice of Sleep Medicine (pp. 53-71). New York: W. B.
Saunders Company.
Buxton, O. M., Lee, C. W., L’Hermite-Baleriaux, M., Turek, R. W., & Van Cauter, E.
(2003). Exercise elicits phase shifts and acute alterations of melatonin that vary
with circadian phase. American Journal of Physiology: Regulatory and
Integrative Comparative Physiology, 284, R714-R724.
O’Neill, T. R., Krueger, G. P., Van Hemel, S. B., McGowan, A. L., & Rogers, W. C.
(1999). Effects of cargo loading and unloading on truck driver alertness (Paper
No. 99-0789). Transportation Research Record, 1686, 42-48.
Fatigue Countermeasure Review Page 4-35

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems

Foods

Definition and Scope


Varying meal content in order to increase alertness or
promote sleep.

Limitations of Use
An attempt to extend an individual’s endurance or promote sleep by altering the
content of meals is unlikely to succeed. It is better to focus on consuming a
nutritionally healthy, and balanced diet at the appropriate times of day.

Advantages to Use

The physical activity associated with eating can itself induce an alerting effect,
however current research evidence suggests that specific food content has little, if
any impact on level of alertness or feelings of sleepiness.

Things to Consider
Getting a balanced, nutritious diet at appropriate times is often difficult for
transportation operators. Schedules often limit eating to what is available when time
and work permit.

Individual’s can avoid this situation with appropriate planning. Packing meals prior to
leaving home, taking rest stops where supermarkets are located, and purchasing
boxed meals from hotels are some steps that can be taken to provide the right foods
are available when needed.

Whenever possible, individual’s should try to eat meals at times that correspond to
their normal meal times – this will help maintain a regular sleep-wake cycle, since
meals are a time cue that influence circadian rhythms.

Consuming large meals prior to sleep can disrupt the subsequent sleep period and
result in gastrointestinal discomfort.
Fatigue Countermeasure Review Page 4-36

Foods such as potatoes, rice, dairy products, turkey, fruits containing glucose, and
sugar speed the amino acid tryptophan to the brain where it is converted to serotonin,
a neurotransmitter that induces sleepiness.

References
Landstrom, U., Knutsson, A., & Lennernas, M. (2000). Field studies on the effects of
food content on wakefulness. Nutrition and Health, 14, 195-204.
Wells, A. S., Read, N. W., Idzikowski, C., & Jones, J. (1998). Effects of meals on
objective and subjective measures of daytime sleepiness. Journal of Applied
Physiology, 84, 507-515.
Fatigue Countermeasure Review Page 4-37

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems

Sound

Definition and Scope


Using sound from sources such as the radio, tapes, or
compact discs to maintain alertness.

Limitations of Use
This countermeasure reduces the effects of fatigue for a very brief period. If an
individual is already sleepy, the countermeasure may have little, if any effect.
Although the brief alerting sound may seem to reduce fatigue, performance will
continue to deteriorate.

The best use of sound is to provide “company” while the individual arranges to take a
break – it is not a substitute for sleep.

Advantages to Use
Turning on the radio or a sound device in the car or other location where the
individual is working is a simple way to change a monotonous environment, and the
change may reduce fatigue or prevent falling asleep for a brief period of time.

This countermeasure briefly increases the physiological arousal level by adding


stimulation to the environment.

Things to Consider
If an individual is getting tired on the job, using this countermeasure may be a useful
means to perk-up for a few minutes until he/she can find an opportunity to pull off the
road, or take a break.
Having a passenger or co-worker to engage in conversation is another means to
increase stimulation.

References
Bonnet, M. H., & Arand, D. L. (2000). The impact of music upon sleep tendency as
measured by the multiple sleep latency test and maintenance of wakefulness test.
Physiology & Behavior, 71, 485-492.
Reyner, L. A., & Horne, J. A. (1998). Evaluation of “in-car” countermeasures to
sleepiness: Cold air and radio. Sleep, 21, 46-50.
Fatigue Countermeasure Review Page 4-38

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems

Odor/Fragrance

Definition and Scope


Use of aromatherapy with scents such as peppermint
or lavender to stimulate alertness or promote sleep.

Limitations of Use
Using a countermeasure that does not work is probably worse than not using one at
all. People in aromatherapy studies tend to rate themselves as more alert after being
exposed to an aroma, but their performance does not change – so they are actually
fooling themselves into thinking that aromatherapy works.

Advantages to Use
There is no scientific evidence that administering a fragrance will enhance alertness,
increase performance, or promote sleep.

Things to Consider
If an individual is feeling fatigued during transportation operations, another
countermeasure should be used.

References
Ilmberger, J., Heuberger, E., Mahrhofer, C., Dessovic, H., Kowarik, D., &
Buchbauer, G. (2001). The influence of essential oils on human attention.
I: Alertness. Chemical Senses, 26, 239-235.
Heuber, E., Hongratanaworakit, T., Cohm, C., Weber, R., & Buchbauer, G. (2001).
Effects of chiral fragrances on human autonomic nervous system parameters and
self-evaluation. Chemical Senses, 26, 281-292.
Fatigue Countermeasure Review Page 4-39

Countermeasures That Do Not Work, Have


Minimal Effects, or Cause Health Problems

Over-the-Counter Sleep Aids

Definition and Scope


Using non-prescription medications to promote sleep.

Limitations of Use
Since there is less scientific evidence regarding the sleep promoting effects of over-
the-counter (OTC) drugs, and there are documented performance degradations and
hangover effects, we do not recommend their use.

Advantages to Use
Many people use OTC products to try and promote sleep; the primary advantage
being that they are available without a prescription. Examples of such products
include Alka-Seltzer PM, Sominex, and many others.

Things to Consider
The principal ingredient in most of the OTC sleep aids is diphenhydramine (Benadryl),
which is an antihistamine. These drugs do appear to have a sedating effect, although
they have not been well-studied because of their unregulated status.

References
The National Sleep Foundation. (2002). Sleep aids: Everything You Wanted to
Know but Were Too Tired to Ask (On-line). Available:
http://www.sleepfoundation.org/publications/sleepaids.html. Accessed April 17,
2003.
Sleep Basics Page 5-1

5. Sleep Basics
How to Use This Section
The information here is organized as a set of individual topics that can be read
sequentially or separately, depending on reader need. The reader will get the best
understanding of how alertness and fatigue result from sleep and brain physiology if
the sections are read sequentially. The individual sections can then be used as
reference material if questions arise later.

The reader can also copy or adapt the contents in each of these topics when
developing educational materials to increase understanding of the basics of sleep and
alertness management.

Introduction
Everyone knows how it feels to get too little sleep. Many people refer to this feeling
as "fatigue" or "sleepiness" – feeling less alert, sometimes exhausted, tending to
crave sleep, and nodding off. The information in this section of the handbook talks
about the basis for alertness, that is, getting adequate sleep. We also talk about the
opposite situation – not getting adequate sleep, some of the reasons why this
happens, and how it affects the level of fatigue and alertness.

Sleep is based on brain physiology and humans have specific requirements for
getting adequate sleep. It is easier to sleep at certain times of the day than others
because of brain mechanisms that have evolved over millions of years. The basic
information in this section will help clarify why it is necessary to get adequate sleep,
why we sometimes don’t, when a person might start feeling fatigued and how it
affects him/her on the job, and what he/she can do to make sure he/she gets
adequate sleep.

Overview of Sleep Basics Topics


The following topics are discussed in the remainder of this section:
• Circadian Rhythms
• Sleep Cycles
• Fatigue, Alertness, and Sleep Loss
• Causes of Sleep Loss
• Getting Adequate Sleep – How to Do It
Sleep Basics Page 5-2

Circadian Rhythms
The term “circadian rhythm” refers to the daily fluctuations in physiological and
psychological functions controlled by the brain’s biological clock. “Circadian” is a term
from the Latin roots circa meaning “about” and dies meaning “day.” The normal
human sleep-wake cycle is based largely on the circadian rhythm, as well as
alertness throughout the day. The brain mechanism that controls the circadian
rhythm is located in the suprachiasmatic nucleus of the hypothalamus (Figure 5-1).

The brain’s biological clock serves as


a pacemaker for numerous daily
cycles, including sleeping and waking,
hormone secretion, digestion, body
temperature regulation, performance
capabilities, and mood. The biological
clock programs humans to operate on
a 24-hour clock so that we are sleepy
at night, and awake during the day.
Also, during daily awake hours, the
circadian rhythm leads to predictable
changes in alertness, such as the
tendency to feel sleepy at some point
during the afternoon (this is
sometimes referred to as the “post-
lunch dip,” although the alertness drop
has little to do with whether you have
eaten). Figure 5-2 illustrates the
circadian rhythm in several physio- Figure 5-1. Location of the brain’s
logical and psychological functions; it biological clock that controls circadian
is noteworthy that when alertness is rhythms.
lowest, i.e., between 2400 and 0500
hours, melatonin levels are the highest – this is because secretion of melatonin by the
brain leads to sleep onset. An individual’s circadian rhythm is sensitive to external
time cues, such as the level of sunlight and patterns of activity in the environment.

Circadian rhythms are important to alertness management because they represent


what the body was designed to do – sleep at night and be awake during the day.
Work schedules that require people to be awake at night and asleep during the day
are challenging primarily because of the circadian rhythm. The biological clock can
adjust to different schedules or time changes, but this takes a certain amount of time,
depending on how extreme the change is. Jet lag, for example, is a situation where
the individual’s rhythm is different from that of the local environment. After a few days
in the new time zone people adapt. It is much more difficult, however, for people to
adapt to work schedules that are opposed to their circadian rhythm because the
normal pattern of light and dark, and daily activities are the same – they do not
change as they do with a time zone shift. Shift workers often switch from one activity-
rest pattern to another, as on weekends, and their circadian rhythm becomes
chronically misaligned with local time.
Sleep Basics Page 5-3

9.
0 Alertness

8.
5
Circadian Rhythms 8.
0
Alertness cycle 7.
5
Core body temperature 00 04 08 12 16 20 00 04
7.
36. 08 12 16 20
0
Hormone secretion 9 Temperature

Melatonin cycle 36.


8
36.
7
36.
6
6 36. 00 04 08 12 16 20 00 04 08
0 Melatonin 5 12 16 20
5 4 Growth Hormone
0 0
4
3
0
0
3
0 2
0
2
0 1
21 23 01 03 05 10pm 11 12 1am
0 2 3 4 5
1
07 09 6 7 8 9
0
Figure 5-2. Circadian rhythms for different physiological and
psychological functions.

When the circadian rhythm is not completely adapted to a person’s work-rest


schedule, on-the-job alertness is affected. This is because the individual is working
when the brain is programmed to sleep, and may not be getting adequate sleep
during off-work periods because of brain programming for wakefulness. This creates
a chronic problem of sleep loss and low sleep quality, which further affects job
performance and alertness.

Circadian Rhythms – Key Points


• The daily cycle of sleeping and waking is controlled by a biological
clock in the brain.
• Circadian rhythms affect alertness during the day.
• The biological clock is sensitive to external time cues such as light
and social activity.
• Humans are programmed to sleep at night and be active during the
day.
• Shift work opposes the circadian rhythm, leading to problems of
sleep loss and low alertness.
• The circadian rhythm can be changed but it is difficult in the
presence of strong time cues.
Sleep Basics Page 5-4

Sleep Cycles
Sleep is a basic physiological need. Most people need about 8 hours of sleep per
night, although some may need as little as six hours, while others may need 10 hours.
On an individual basis, the amount of sleep a person requires is that amount
necessary to achieve full alertness and effortless functioning during the waking hours,
even when sitting quietly and being bored. When an individual feels that they must
keep moving to stay alert, that is strong sign that they are not getting sufficient sleep.

Sleep is a physiological process that can be monitored by brain electrical activity. As


a person relaxes from their waking state, brain electrical activity slows progressively,
until the deepest level of sleep (Stage 4) occurs. Figure 5-3 illustrates the various
stages of sleep, which progress through a cycle that repeats throughout the night.

As a person drifts off to sleep, he/she enters Stage 1. This is followed by a slowing of
the heart rate and relaxing of muscle tension as Stage 2 is entered. In Stages 3 and
4, slow wave brain activity is associated with very deep and restorative levels of
sleep. During these stages it is particularly difficult to wake the person. Rapid Eye
Movement (REM) sleep occurs throughout the cycle and shows a brain activity
pattern similar to Stage 1 or waking; this sleep stage is associated with dreaming.

Classification of Sleep
 Awake  Sleep
 REM
 Light
 Deep

Awake

Stage1 REM

Stage2 (Light)

Stage3 (Deep)

Stage4 (Deep)

Figure 5-3. Brain electrical activity (on left) illustrates the stages of sleep
(on right), which progress in a cyclic fashion through the sleep period.
When people take a nap during the work day for about an hour or more, they are
likely to fall into the deeper stages of sleep (Stages 3 and 4) and when they awaken
from such deeper sleep, they are likely to experience “sleep inertia,” which is
grogginess that can last up to 15 or 20 minutes. To gain the benefits of a nap during
the work day, and to avoid such sleep inertia, it is suggested they take a nap for 45
Sleep Basics Page 5-5

minutes or less, as this decreases the risk of falling into the deeper sleep stages and
having the inertia upon awakening.

With respect to a person's principal sleep for a 24-hour period, it is important that the
entire cyclic process of sleep be completed in order to receive the restful effects of a
sleep period. Anything that interferes with sleep, such as noise disruptions,
medication, alcohol, or simply insufficient duration, will change the physiological
structure of the sleep cycles and impair alertness the next day.

Sleep is affected by aging. Although older people need as much sleep as younger
people, they sleep less soundly and experience more awakenings during the night
and shifts from one sleep stage to another. Medical conditions common in older folks
make sleep disruptions more likely. A prime result of sleep disruptions is increased
daytime sleepiness and more napping during the day – which paradoxically can affect
the quantity and quality of night time sleep.

People also differ from one another in their preferred activity and sleep times. “Larks”
tend to be “morning people,” arising early and getting to sleep early. “Owls” tend to
stay up later at night and arise later in the morning. Owls tend to perform better on
afternoon and evening shifts. People usually fall somewhere on a scale between
being a total lark or owl.

Sleep Cycles – Key Points


• Sleep is a basic physiological need.
• Sleep is a complex process consisting of multiple stages, some
“deeper” and more restful than others.
• Rapid Eye Movement (REM) sleep occurs throughout the night
and often involves dreaming.
• Upon awakening, people experience temporary grogginess called
“sleep inertia” which usually disappears in 15 minutes.
• Anything that interferes with the duration or cyclic structure of
sleep will reduce alertness the next day.
• Aging is associated with increased sleep disruptions leading to
daytime sleepiness.
• People differ in their preference for early or late schedules
(larks vs. owls).
Sleep Basics Page 5-6

Fatigue, Alertness, and Sleep Loss


When people do not get adequate sleep, they experience fatigue and loss of
alertness during the time they are awake. This affects their ability to perform safely
on the job. Sleep loss of even 1 or 2 hours can significantly degrade alertness and
performance, with greater effects for increasing amounts of sleep loss.

If a person loses sleep over successive days, this can lead to an accumulated sleep
debt. For example, if someone who needs 8 hours of sleep only gets 5 hours a night
over 4 nights (i.e., over four 24-hour days), he/she would accumulate a sleep debt of
12 hours. This can result in a cumulative effect on alertness and performance over
that period of time. Frequently, we tend to gain some recovery sleep over our
“weekends” or our 2 days off from work. However, recuperation from sleep debt
requires getting more sleep for at least several nights. The effects of large sleep
debts, say not sleeping for 2 days, can still be detected in performance levels after a
week of sleeping normally for 7 to 8 hours per night.

Chronic sleep loss can contribute to health consequences, including obesity,


diabetes, and high blood pressure. Even young people who experience sleep debt
over a week show increased likelihood of infection and stress effects. Shift workers
commonly experience sleep loss and are more prone to gastrointestinal disorders, as
well as aggravations of cardiovascular disease and diabetes.

If there is enough reduction in sleep, people will reach a level of critically reduced
alertness in which sleep spontaneously intrudes into wakefulness. These
uncontrolled sleep episodes (microsleeps) can occur even when a person is standing
up or operating equipment. It is important to recognize the signs and symptoms of
fatigue, and to ensure that workers are getting sufficient rest to maintain alertness on
the job.

Signs and Symptoms of Fatigue


• Poor • Bad
• Forgetful
communication mood
• Noddin
• Poor decision making • Fixated
g off
• Itchy
• Slowed reaction time • Apathetic
eyes
Sleep Basics Page 5-7

Causes of Sleep Loss


One of the main causes of sleep loss is shift work, i.e., working during hours outside
the normal daylight routine. Figures 5-4a and 5-4b show the typical pattern of day
work, and night rest. This pattern is altered, or sometimes reversed for shift workers,
and can lead to difficulties sleeping. The primary reason for sleep loss in shift
workers is that they are trying
to sleep at times when the
brain’s biological clock
mechanism signals that they
should be awake. As a
consequence, shift workers
may find it more difficult to go
to sleep, or to sleep as long
as they wish.

Social and family demands


can contribute to the sleep
loss problems experienced by
shift workers, because they
may choose to spend more
time in these activities at the
expense of trying to rest.
Many people who work
afternoon or night shifts revert
to a normal daytime schedule
on the weekends or days off,
Figure 5-4a. The normal daily routine for in order to synchronize with
sleep and work. the world-at-large. This can
lead to a constant state of
“circadian desynchronization”
in which the body and the daily clock are in conflict.

A number of substances can interfere with sleep, including caffeine, alcohol, and
over-the-counter drugs such as decongestants. The effects of caffeine typically last
for about 4 to 5 hours,
but may last up to 10
hours in especially Average Sleep Length Chart
sensitive individuals, so
a cup of coffee after
dinner may well
interfere with getting to
sleep. Similarly, alcohol
may initially relax a
person and assist in
getting to sleep, but as
it is metabolized there
will be a “rebound”
alerting effect, causing
a person to awaken
more easily. Alcohol Figure 5-4b. Sleeping at times not favored by the
brain’s biological clock results in less sleep.
Sleep Basics Page 5-8

also interferes with REM sleep. Nasal decongestants interfere with sleep because
they contain pseudoephedrine, which is a stimulant.

Other activities that may interfere with sleep include eating and exercise.
Consumption of specific foods can stimulate gastrointestinal reactions that may result
in discomfort and sleep problems. Exercise on a regular basis is good for promoting
sound sleep, but should not be done within an hour or two of bedtime, because it has
an alerting function and can shift the biological clock forward.

Specific sleep disorders also result in sleep loss. Among the most common of these
are medical conditions such as congestive heart failure and arthritis that lead to the
symptom of insomnia (i.e., difficulty in getting to sleep or staying asleep). The
condition, sleep apnea, affects as many as 5 out of every 100 people and is a
breathing disorder involving periodic interruptions of breathing during sleep. Key
signs that a person has sleep apnea are reports from others that the person snores
loudly and irregularly when sleeping. Medical specialists can be consulted to
determine if a specific condition exists that is interfering with sleep, and proper
medical interventions can help to alleviate the problem.

Causes of Sleep Loss – Key Points


• Shift work causes conflicts between the brain’s biological clock and
when a person works and sleeps.
• Daytime sleep periods result in less sleep because of the influence
of the biological clock, and family/social demands.
• Caffeine, alcohol, and over-the-counter decongestants interfere
with sleep.
• Food or exercise too close to a sleep period can result in sleep
loss.
• Specific sleep disorders, such as insomnia or sleep apnea, cause
sleep loss.
Sleep Basics Page 5-9

Getting Adequate Sleep – How to Do It


The demanding world we live in makes getting adequate sleep challenging. But
knowledge of some basic information and approaches can help people make the
most of their rest periods to obtain sufficient sleep so they will be alert on the job.

There are four basic areas to consider for ensuring


that a person gets adequate sleep:
1. The personal sleep cycle
2. Sleep environment
3. Relaxation
4. Things to avoid

Understanding the individual sleep cycle is crucial for


taking the steps to ensure sufficient restorative sleep. People can determine their
optimum sleep amount by recording their sleep start and stop times on their third
consecutive day off when they are not using an alarm clock to wake up. This is most
likely to occur when you take a vacation.

The amount of sleep needed should be enough to feel refreshed and healthy the next
day but not more – this will usually be between 7.5 and 8.5 hours. Based on the
amount of sleep needed, people should establish a habitual time for going to sleep
and waking up, and maintain this schedule whether or not it is a workday.
Additionally, daily exercise helps to promote sounder sleep.

The sleep environment should be quiet and dark, using room-darkening shades if
necessary. Earplugs can be helpful if there is noise. The temperature of the sleeping
room should be around 65° F, and the bed should be used only for sleeping – not for
activities such as reading or watching television.

Relaxation can promote falling asleep. The most basic technique is for the individual
to wait until feeling sleepy before going to bed. If the individual is not tired, he/she
should do something quiet and relaxing like reading or watching TV in dim light until
he/she feels sleepy. Once in bed, if he/she cannot sleep, it is best to get out of bed
and do some quiet activity until you feel sleepy.

Getting good sleep depends on knowing what to avoid prior to sleeping. Especially
important to avoid is caffeine – this should be avoided within about 5 or 6 hours of
going to sleep, since the effects can last that long. It is also important to avoid
drinking alcohol within 3 hours of bedtime, since alcohol fragments sleep and makes it
less restorative. Cutting down or eliminating nicotine is important for promoting good
sleep. It is also important to try to avoid thinking about the day’s problems – possibly
by writing “to do” lists for the next day to clear the mind. Drinking fewer fluids before
going to sleep will reduce awakenings to use the bathroom. Finally, a nap should be
taken during the day only if there is no trouble going to sleep at night.
Sleep Basics Page 5-10

Getting Enough Sleep – How to Do It: Key Points


• Make bedtime and waking a routine schedule to get the amount of
sleep necessary.
• Ensure the environment is dark and quiet, and not too warm.
• Relax prior to bedtime; don’t toss and turn – get out of bed and do
something quiet until sleepy.
• Avoid caffeine and alcohol prior to bedtime, eliminate nicotine,
drink fewer fluids to reduce use of bathroom, and avoid thinking about
problems.
• Nap during the day only if it does not interfere with going to sleep
at night.
References Page R-1

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Additional Information Sources Page A-1

Additional Information Sources


This section provides references to fatigue-related information that were not cited in
the main body of this document, but would be useful to those interested in a specific
aspect of fatigue management. These references are alphabetized within eight
general topics, listed below and at the beginning of each topic.

1. Fatigue-Related Job Performance and Accidents


2. Fatigue Modeling and Prediction
3. Alertness Monitoring Research
4. Regulatory Review and Guidance
5. Fatigue Contributing Factors
6. Fatigue Management Program Guidance
7. Fatigue Management Countermeasures
8. Fatigue Management Outcome Research

FATIGUE-RELATED JOB PERFORMANCE AND ACCIDENTS


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accidents. Washington, DC: Transportation Research and Marketing.
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Kaneko, T., & Jovanis, P. P. (1992). Multiday driving patterns and motor carrier
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Additional Information Sources Page A-3

Stutts, J. C., Wilkins, J. W., & Vaughn, B. V. (1999). Why do people have drowsy
driving crashes? Washington, DC: AAA Foundation for Traffic Safety.
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Annual Meeting, 2, 952-956.

FATIGUE MODELING AND PREDICTION


Åkerstedt, T. (1997). Available countermeasures against operator fatigue. In: W. C.
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the S and C components of the three-process model of alertness regulation.
Sleep, 18(1), 1-6.
Åkerstedt, T., & Folkard, S. (1997). The three-process model of alertness and its
extension to performance, sleep latency, and sleep length. Chronobiology
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Belenky, G., Balkin, T. J., Redmond, D. P., Sing, H. C., Thomas, M. L., Thorne, D. R.,
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Macdonald, I., & Costa, G. (1999). A process model of shiftwork and health.
Journal of Occupational Health Psychology, 4, 207-218.

ALERTNESS MONITORING RESEARCH


Abrams, C., Schultz, T., Wylie, C. S. (August 1997). Commercial motor vehicles
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Carroll, R. J. (Ed.). (September 1999). Ocular measures of driver alertness:


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Washington, DC: Office of Motor Carrier and Highway Safety, Federal Highway
Administration, U.S. Department of Transportation.
Carskadon, M. A., & Dement, W. C. (1982). The multiple sleep latency test: What
does it measure? Sleep, 5, S67-S72.
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Della Rocco, P. S., Comperatore, C., Caldwell, L., & Cruz, C. (2000). The effects of
napping on night shift performance (FAA CAMI Technical Report No.
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Additional Information Sources Page A-16

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Subject Index Page S-1

Subject Index

A
Adequate sleep, 2-2, 2-4, 4-1, 4-4, 5-1, 5-3, 5-6, 5-9
Aging, 5-5
Alcohol, 2-13, 4-18, 5-5, 5-7, 5-8, 5-9, 5-10
Alerting, 4-20, 4-30, 4-36, 5-7, 5-8
Alertness aids, 4-6
Alertness maintenance monitoring, 4-1, 4-20
Alka-Seltzer PM, 4-38
Ambien, 4-26
Amphetamine, 4-25
Anchor sleep, 4-1, 4-10, 4-11
Antihistamine, 4-38
Arthritis, 5-8
Association of American Railroads, 3-4, 3-8

B
Benadryl, 4-38
Biological clock, 5-2, 5-3, 5-7, 5-8
Body temperature regulation, 5-2
Brain activity pattern, 5-4
Brain’s biological clock, 5-2, 5-7
Breathing disorder, 5-8
Bright light, 4-1, 4-22
British Airways, 3-8
Burlington Northern Santa Fe, 3-8

C
Caffeine, 2-13, 4-1, 4-6, 4-7, 4-11, 4-16, 4-24, 4-27, 4-30, 5-7, 5-8, 5-9, 5-10
Cardiovascular disease, 5-6
Chamomile, 4-26
Changing or rotating work schedules, 2-1, 2-8
Chocolate, 4-6
Circadian desynchronization, 5-7
Circadian rhythm, 2-1, 2-6, 2-11, 3-6, 4-4, 4-10, 4-11, 4-16, 4-22, 4-23, 4-28, 4-29, 4-32,
4-33, 4-34, 5-1, 5-2, 5-3
Coffee, 4-6, 4-11, 5-7
Commuting, 2-1, 2-2
Compensatory sleep, 4-5
Congestive heart failure, 5-8
Core body temperature, 5-3
Subject Index Page S-2

D
Dalmane, 4-26
Daytime sleep periods, 5-8
Daytime sleepiness, 2-11, 5-5
Decongestants, 4-24, 4-25, 5-7, 5-8
Dextroamphetamine, 4-24, 4-25
Diabetes, 5-6
Diet, 2-1, 2-13, 3-5, 4-2, 4-34
Digestion, 5-2
Diphenhydramine, 4-38
Doral, 4-26
Dreaming, 5-4, 5-5

E
Earplugs, 4-14, 5-9
Eating, 2-13, 5-8
Education and training, 3-1, 3-4, 3-5
Emergency nap, 4-9
Employee – employer partnership, 3-1, 3-4
Employee health screening, 3-1, 3-7
Ephedra, 4-24, 4-25
Exercise, 2-1, 2-12, 3-5, 4-2, 4-27, 4-32, 4-33, 5-8, 5-9
Extended work, 2-1, 2-2, 2-12
External time cues, 5-2

F
Falling asleep, 4-21, 4-26, 4-32, 4-36, 5-9
Family/social demands, 5-8
Fatigue management program, 1-1, 1-2, 3-1, 3-2, 3-5, 3-8, 4-21
Fatigue, alertness, and sleep loss, 5-1, 5-6
Fencamfamin, 4-25
Fitness for duty testing, 4-1, 4-18
Fluids, 2-14, 5-9, 5-10
Food consumption, 5-8
Forward rotating schedule, 4-22

G
Gastrointestinal disorders, 5-6
Gastrointestinal reactions, 5-8
Good sleeping environment, 4-1, 4-14
Green wavelength, 4-23
Grogginess, 5-4, 5-5
Growth hormone, 5-3
Subject Index Page S-3

H
Halcion, 4-26
Heart rate, 2-14, 5-4
High blood pressure, 5-6
Hormone secretion, 5-2, 5-3
Hours-of-Service Rules, 2-2, 2-7, 3-2
Hours-of-Service, 2-2, 2-7, 3-2, 3-3
Hypothalamus, 5-2

I
Inadequate exercise, 2-1, 2-12
Individual sleep cycle, 5-9
Insomnia, 3-7, 4-6, 4-14, 4-24, 4-26, 5-8

J
Jet lag, 2-6, 4-4, 4-26, 4-28, 5-2

K
Kava, 4-26

L
Lack of rest or nap periods, 2-1, 2-10
Lark, 4-5, 5-5
Lavender, 4-26, 4-37
Level of sunlight, 5-2
Levels of sleep, 5-4
Levo-amphetamine, 4-25
Light, 2-11, 4-1, 4-14, 4-22, 4-23, 4-28, 4-32, 5-2, 5-3, 5-9
Long commutes, 2-2

M
Mazindol, 4-25
Melatonin, 4-1, 4-2, 4-23, 4-28, 4-29, 5-2, 5-3
Metabolism, 5-3
Methamphetamine, 4-25
Methylphenidate, 4-25
Microsleeps, 5-6
Modafinil, 4-24, 4-25
Models of alertness, 4-1, 4-16
Mood, 4-30, 5-2, 5-6
Muscle tension, 5-4
Subject Index Page S-4

N
Napping, 2-10, 4-1, 4-5, 4-8, 4-9, 5-5
Nasal decongestants, 5-8
Nicotine, 4-2, 4-30, 5-9, 5-10
NoDoz, 4-6
Noise, 2-11, 2-14, 2-15, 4-14, 5-5, 5-9

O
Obesity, 5-6
Odor/fragrance, 4-2, 4-37
Operator status monitors, 4-20
Organizational commitment, 3-1, 3-2
Over-the-counter (OTC)
cold medications, 4-6
decongestants, 4-24, 5-8
drugs, 4-38, 5-7
sleep aids, 4-2, 4-38
Owl, 4-5, 5-5

P
Pacemaker, 5-2
Pemoline, 4-25
Performance, 2-14, 3-8, 4-12, 4-18, 4-20, 4-21, 4-24, 4-30, 4-32, 4-36, 4-37, 4-38, 5-2,
5-3, 5-6
Periodic interruptions of breathing during sleep, 5-8
Personal sleep cycle, 5-9
Poor diet, 2-1, 2-13
Post-lunch dip, 5-2
Program evaluation and refinement, 3-1, 3-2
ProSom, 4-27
Pseudoephedrine, 4-24, 5-8

R
Rapid eye movement (REM), 5-4, 5-5, 5-8
Reading or television watching, 5-9
Recuperation, 5-6
Relaxation, 5-9
REM sleep, 5-4, 5-8
Rest intervals, 4-12
Restoril, 4-26, 4-27
Subject Index Page S-5

S
Sedatives/hypnotics, 4-2, 4-26
Shift work, 2-1, 2-4, 2-5, 2-7, 3-4, 3-6, 5-7, 5-8
Sleep
adequate, 2-4, 3-6, 4-1, 4-4, 5-1, 5-3, 5-6, 5-9
amount, 4-10, 4-26, 5-4, 5-9, 5-10
awakenings, 5-5, 5-9
optimum, 5-9
Sleep apnea, 3-7, 5-8
Sleep at night, 5-2, 5-3, 5-9
Sleep basics, 1-2, 5-1
Sleep cycles, 5-1, 5-4, 5-5
Sleep debt, 2-2, 4-4, 4-5, 4-9, 5-6
Sleep disorders, 3-6, 3-7, 4-24, 4-25, 5-8
Sleep disruption, 2-1, 2-11, 3-7, 5-5
Sleep environment, 4-4, 4-5, 4-14, 4-27, 5-9
Sleep inertia, 5-4, 5-5
Sleep loss, 4-4, 4-5, 4-24, 4-26, 5-1, 5-3, 5-6, 5-7, 5-8
causes, 5-1, 5-7
chronic, 5-3, 5-6
Sleep start time, 5-9
Sleep stop time, 5-9
Sleep-wake cycle, 4-34, 5-2, 5-3
Soft drinks, 4-6
Sominex, 4-38
Sonata, 4-27
Sound, 4-2, 4-14, 4-36
Split-shift work schedule, 2-1, 2-4, 2-5, 2-7
Split-shift, 2-1, 2-4, 2-5, 2-7, 2-10
Square watch, 2-4, 2-6
Stages of sleep, 5-4
Stimulant, 4-1, 4-6, 4-24, 4-25, 4-30, 5-8
Strategic naps, 4-9, 4-12
Supplemental sleep, 4-10, 4-11

T
Tea, 4-6
Time cues, 4-22, 4-32, 5-2, 5-3
Time zone shift, 5-2
Time zone travel, 2-6
Tobacco, 4-2, 4-30
Trip planning, 4-1, 4-12

U
Union Pacific Railroad, 3-5
Unpredictable work schedules, 2-1, 2-9
Subject Index Page S-6

V
Valerian root, 4-26
Ventilation and temperature, 4-2, 4-31
Vivarin, 4-6

W
Washington State Ferry System, 3-4
Work schedules, 2-1, 2-4, 2-6, 2-8, 2-9, 2-12, 3-4, 3-5, 4-10, 5-2

Z
Glossary Page G-1

Glossary
Alertness - the optimal activated state of the brain. A heightened state of physical and
mental readiness that is optimal for an individual to perform functions. Alertness is a
dynamic state and may vary from second to second.

Arousal - a change in an individual from sleep to awake. Partial arousal refers to the
transition from a deep sleep stage to a lighter sleep stage. Full arousal is when an
individual is fully awake and cognizant.

Awake – individual is conscious and aware of their surroundings.

Biological Clock – a bundle of nerves in the brain that regulates the timing of biological
functions, including the daily fluctuations in alertness. Also referred to as the internal
clock or circadian clock. The biological clock regulates and maintains the circadian
rhythm.

Circadian Disruption – a disturbance of the circadian rhythm that can result from flying
across multiple time zones, working irregular schedules, working at night, or exposure to
light at irregular times of day.

Circadian Rhythm – circa translates as “around or about” and diem translates as “day”,
so circadian rhythms are biological rhythms that have a period of approximately 1 day (24
hours).

Deep-draft Vessels – vessels that typically operate in open-ocean and deep waters.

Fatigue – a condition of degraded capacity to perform physical or cognitive functions due


to overexertion, or insufficient or poor quality sleep.

Fatigue Management – activities designed to identify and control factors (environmental,


organizational, regulatory, and individual) that contribute to fatigue.

Long-haul Operations – operations that typically require being away from home
continuously for multiple days.

Main Sleep – period when an individual gets the majority of their daily sleep.

Melatonin – a hormone produced by the pineal gland in the brain that is a biological
marker for the onset of sleep

Phase Advance – the movement of the circadian rhythm to an earlier orientation. If an


individual typically gets up at 0800 and begins getting up at 0500, the circadian rhythm
will phase advance.

Phase Delay – the movement of the circadian rhythm to a later orientation. If an


individual typically gets up at 0500 and begins getting up at 0800, the circadian rhythm
will phase delay.
Glossary Page G-2

Shift-lag – a condition similar to jet-lag where irregular or rotating work schedules disrupt
circadian rhythms similar to flying multiple time zones.

Sleep Debt – a condition, where person gets less than his/her biological sleep need, that
can result in fatigue and sleepiness.

Sleep Hygiene – the conditions and practices that promote good sleep. These include
regular sleep timing, limiting alcohol and caffeine before sleep, controlling noise, light and
temperature, and good quality bedding.

Sleep Inertia – a feeling of lethargy immediately after awakening from sleep or a nap.

Sleep Latency – the length of time it takes to fall asleep.

Tryptophan – an amino acid that is converted to serotonin, a sleep-inducing


neurotransmitter

Rotating Work Schedule – work schedules that vary. Schedules can vary daily, weekly,
or monthly. Forward or clockwise rotations - go from day, to afternoon/evening, and end
with night. Backward or counterclockwise rotations - go from night, to afternoon/evening,
and end with morning.

Sleep Stages – the brain goes through 5 stages of sleep, beginning with light sleep
(stages 1 & 2) and progressing to deep sleep (stages 3 & 4). The 5th stage, Rapid Eye
Movement (REM) occurs after deep sleep and is associated with dreaming. The brain
needs all 5 stages of sleep to achieve physical and mental restoration.

Split-shift – work schedules that are split into multiple periods rather than one
continuous work period. These schedules can produce very long workdays especially if
there is a morning work period followed by some hours off and ending with another work
period.